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General NPI Number Information
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NPI Number | 1922022458
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Entity Type | Individual
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Provider Name | PETER UNG KWON KIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 1770 E LAMBERT RD STE 110
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City | BREA
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State | CA
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Zip | 92821-8001
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Country | US
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Telephone | 714-529-0100
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Fax | 714-599-9898
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Provider Business Mailing Address
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Address Line | 1770 E LAMBERT RD STE 110
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City | BREA
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State | CA
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Zip | 92821-8001
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Country | US
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Telephone | 714-529-0100
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Fax | 714-599-9898
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49769
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License Number State | CA
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