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General NPI Number Information
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NPI Number | 1821574864
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Entity Type | Organization
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Legal Business Name | IL-SEON KIM, DDS, INC
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1722 DESIRE AVE 201
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748
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Country | US
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Telephone | 626-964-1884
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 DESIRE AVE
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2968
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Country | US
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Telephone | 626-964-1884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IL SEON KIM
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Credential | DDS
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Telephone | 626-964-1884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 33302
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License Number State | CA
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