Provider Demographics
NPI:1053626556
Name:KIM, SOON NO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOON NO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2814 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2863
Mailing Address - Country:US
Mailing Address - Phone:310-539-5300
Mailing Address - Fax:310-539-0843
Practice Address - Street 1:2814 SEPULVEDA BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2863
Practice Address - Country:US
Practice Address - Phone:310-539-5300
Practice Address - Fax:310-539-0843
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460841223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics