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General NPI Number Information
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NPI Number | 1972964260
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Entity Type | Individual
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Provider Name | SEUNG HWAN KIM D.D.S
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Gender | Male
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13252 CENTURY BLVD STE Q
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1257
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Country | US
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Telephone | 714-591-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 16614 ADLER RD
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City | LA MIRADA
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State | CA
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Zip | 90638-6587
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Country | US
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Telephone | 213-505-2088
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Fax |
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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 | 65350
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License Number State | CA
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