Provider Demographics
NPI:1407048192
Name:KIM, SARAH SOONYOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:SOONYOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11467 VIA CAPRI
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3853
Mailing Address - Country:US
Mailing Address - Phone:310-614-3593
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DR STE 309
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6324
Practice Address - Country:US
Practice Address - Phone:909-380-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist