Provider Demographics
NPI:1205043395
Name:BRIAN SONGSU KIM
Entity Type:Organization
Organization Name:BRIAN SONGSU KIM
Other - Org Name:HOMETOWN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTISTOWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SONGSU
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-725-9430
Mailing Address - Street 1:1406 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2222
Mailing Address - Country:US
Mailing Address - Phone:661-725-9430
Mailing Address - Fax:661-725-7221
Practice Address - Street 1:1406 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2222
Practice Address - Country:US
Practice Address - Phone:661-725-9430
Practice Address - Fax:661-725-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty