Provider Demographics
NPI:1396851630
Name:KIM, JAMES JINSOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JINSOO
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 1:240 E HIGHWAY 246
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9645
Mailing Address - Country:US
Mailing Address - Phone:805-688-8400
Mailing Address - Fax:805-688-0575
Practice Address - Street 1:240 E. HWY 246
Practice Address - Street 2:SUITE 108
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427
Practice Address - Country:US
Practice Address - Phone:805-688-8400
Practice Address - Fax:805-688-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44910122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist