Provider Demographics
NPI:1528011624
Name:KIM, JAMES S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 BROADWAY
Mailing Address - Street 2:#700
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1923
Mailing Address - Country:US
Mailing Address - Phone:650-697-6691
Mailing Address - Fax:
Practice Address - Street 1:485 BROADWAY
Practice Address - Street 2:#700
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1923
Practice Address - Country:US
Practice Address - Phone:650-697-6691
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice