Physician Compare National (NPI:1003035114)

HEALTHCARE PROVIDER: KWANG SEOB KIM D.D.S

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1003035114
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810221934
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190624002964
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIM
	Individual professional last name
Provider First Name	KWANG
	Individual professional first name
Provider Middle Name	SEOB
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	MAXILLOFACIAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	DENTIST
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	DENTIST
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	12309 CARSON ST
	Group Practice or individual's line 1 address
City	HAWAIIAN GARDENS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	907161603
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y