Provider Demographics
NPI:1558448704
Name:KIM, DAVID H (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
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 1:1007 WEST LA PALMA AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3620
Mailing Address - Country:US
Mailing Address - Phone:714-778-6160
Mailing Address - Fax:714-778-2800
Practice Address - Street 1:1007 WEST LA PALMA AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3620
Practice Address - Country:US
Practice Address - Phone:714-778-6160
Practice Address - Fax:714-778-2800
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2777701Medicaid