Provider Demographics
NPI:1336476373
Name:KIM, MICHAEL HWANGSUK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HWANGSUK
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 1:12865 MAIN ST
Mailing Address - Street 2:#201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840
Mailing Address - Country:US
Mailing Address - Phone:714-530-7888
Mailing Address - Fax:714-530-1344
Practice Address - Street 1:12865 MAIN ST
Practice Address - Street 2:#201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-8205
Practice Address - Country:US
Practice Address - Phone:714-530-7888
Practice Address - Fax:714-530-1344
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369531223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty