Provider Demographics
NPI:1467521443
Name:KIM, BRIAN CHONG-HAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHONG-HAN
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 1:222 N G ST
Mailing Address - Street 2:#3
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3217
Mailing Address - Country:US
Mailing Address - Phone:909-383-7777
Mailing Address - Fax:909-383-7779
Practice Address - Street 1:222 N G ST
Practice Address - Street 2:#3
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3217
Practice Address - Country:US
Practice Address - Phone:909-383-7777
Practice Address - Fax:909-383-7779
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice