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General NPI Number Information
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NPI Number | 1861946683
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Entity Type | Individual
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Provider Name | HAN S. KIM DMD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2480 LLEWELLYN AVE
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City | FORT MEADE
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State | MD
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Zip | 20755-7081
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Country | US
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Telephone | 310-993-1836
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 FLYNN RD
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City | CAMARILLO
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State | CA
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Zip | 93012-5092
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Country | US
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Telephone | 805-673-3930
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Fax | 805-659-3217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 65331
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 65331
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License Number State | CA
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