Provider Demographics
NPI:1013210426
Name:KIM, STEVE G (DDS)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:G
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DEERWOOD RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4409
Mailing Address - Country:US
Mailing Address - Phone:925-718-8970
Mailing Address - Fax:925-718-8971
Practice Address - Street 1:111 DEERWOOD RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4409
Practice Address - Country:US
Practice Address - Phone:925-718-8970
Practice Address - Fax:925-718-8971
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA586191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice