Provider Demographics
NPI:1598718538
Name:HANNAFORD, KIM KARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:KARL
Last Name:HANNAFORD
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 1:3532 HOWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3681
Mailing Address - Country:US
Mailing Address - Phone:562-795-7777
Mailing Address - Fax:562-795-7779
Practice Address - Street 1:3532 HOWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3681
Practice Address - Country:US
Practice Address - Phone:562-795-7777
Practice Address - Fax:562-795-7779
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice