=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952257180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINGI KIM DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2026
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7750 DAGGET ST STE 104
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-874-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7750 DAGGET ST STE 104
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-874-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MINGI KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-874-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------