Provider Demographics
NPI:1003950627
Name:KIM, ROSE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:27885 SMYTH DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4011
Mailing Address - Country:US
Mailing Address - Phone:661-294-1800
Mailing Address - Fax:661-294-9774
Practice Address - Street 1:27885 SMYTH DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4011
Practice Address - Country:US
Practice Address - Phone:661-294-1800
Practice Address - Fax:661-294-9774
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954652626OtherGOLDEN WEST
CA954652626OtherANTHEM
CA954652626OtherCORE SOURCE
CA954652626OtherBLUE SHIELD
CA954652626OtherAETNA
CA954652626OtherWASHINGTON DENTAL SERVICE
CA954652626OtherBLUE CROSS
CA954652626OtherASSURANT EMPLOYEE BENEFIT
CA954652626OtherDELTA DENTAL
CA273749OtherUNITED CONCORDIA
CA954652626OtherFORTIS
CA954652626OtherPACIFIC CARE
CA954652626OtherGENWORTH FINANCIAL
CA954652626OtherEBA
CA954652626OtherCONNECTICUT GENERAL
CA954652626OtherUNITED HEALTHCARE
CA954652626OtherCARPENTERS HEALTH & WELFA
CA954652626OtherDELTA USA
CA954652626OtherMET LIFE