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General NPI Number Information
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NPI Number | 1689198806
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Entity Type | Organization
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Legal Business Name | SEUNG HWAN KIM, DDS, INC
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Dates
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Enumeration Date | 07/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13252 CENTURY BLVD STE Q
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1257
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Country | US
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Telephone | 714-591-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 13252 CENTURY BLVD STE Q
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1257
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Country | US
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Telephone | 714-591-5190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEUNG HWAN KIM
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Credential | DDS
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Telephone | 213-505-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 65350
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License Number State | CA
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