Provider Demographics
NPI:1518053420
Name:KIM, IL SEON (DDS)
Entity Type:Individual
Prefix:DR
First Name:IL SEON
Middle Name:
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 1:1722 DESIRE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2968
Mailing Address - Country:US
Mailing Address - Phone:626-964-1884
Mailing Address - Fax:626-964-6259
Practice Address - Street 1:1722 DESIRE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2968
Practice Address - Country:US
Practice Address - Phone:626-964-1884
Practice Address - Fax:626-964-6259
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist