Provider Demographics
NPI:1285650275
Name:KIM, HONG KU (DDS)
Entity Type:Individual
Prefix:DR
First Name:HONG
Middle Name:KU
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 1:2379 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4263
Mailing Address - Country:US
Mailing Address - Phone:626-584-7017
Mailing Address - Fax:626-584-9227
Practice Address - Street 1:2379 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4263
Practice Address - Country:US
Practice Address - Phone:626-584-7017
Practice Address - Fax:626-584-9227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist