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General NPI Number Information
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NPI Number | 1689862617
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Entity Type | Organization
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Legal Business Name | BRIAN J. KIM, DDS, MSD, INC.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 10515 BALBOA BLVD SUITE 280
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6343
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Country | US
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Telephone | 818-363-7900
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Fax | 818-368-7111
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Provider Business Mailing Address
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Address Line | 10515 BALBOA BLVD SUITE 280
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6343
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Country | US
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Telephone | 818-363-7900
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Fax | 818-368-7111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN KIM
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Credential | D.D.S., M.S.D.
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Telephone | 818-363-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 48133
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License Number State | CA
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