Provider Demographics
NPI:1568479319
Name:KIM, DAVID H (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4448 E VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1540
Mailing Address - Country:US
Mailing Address - Phone:562-421-9369
Mailing Address - Fax:562-420-8950
Practice Address - Street 1:4448 E VILLAGE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1540
Practice Address - Country:US
Practice Address - Phone:562-421-9369
Practice Address - Fax:562-420-8950
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOMS 631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery