Provider Demographics
NPI:1578712758
Name:KIM, MANYONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANYONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:M( MANYONG)
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3533 E CHAPMAN AVE STE L
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3850
Mailing Address - Country:US
Mailing Address - Phone:714-744-6000
Mailing Address - Fax:714-771-7900
Practice Address - Street 1:3533 E CHAPMAN AVE STE L
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3850
Practice Address - Country:US
Practice Address - Phone:714-744-6000
Practice Address - Fax:714-771-7900
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist