Provider Demographics
NPI:1538287503
Name:KIM, SANDY SOYON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:SOYON
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 1:9636 GARDEN GROVE BLVD
Mailing Address - Street 2:STE. #3
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1530
Mailing Address - Country:US
Mailing Address - Phone:714-590-2828
Mailing Address - Fax:
Practice Address - Street 1:9636 GARDEN GROVE BLVD
Practice Address - Street 2:STE. #3
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1530
Practice Address - Country:US
Practice Address - Phone:714-590-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44909-01OtherMEDICAL