Provider Demographics
NPI:1356827737
Name:KIM, DAEUK DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAEUK
Middle Name:DAVID
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAEUK
Other - Middle Name:DAVID
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:144 WATERFALL LN
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4348
Mailing Address - Country:US
Mailing Address - Phone:510-926-9414
Mailing Address - Fax:
Practice Address - Street 1:144 WATERFALL LN
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4348
Practice Address - Country:US
Practice Address - Phone:510-926-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist