Provider Demographics
NPI:1609051838
Name:KIM, EUGENE DUEJIN (DDS)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:DUEJIN
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 1:5861 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2021
Mailing Address - Country:US
Mailing Address - Phone:714-994-2501
Mailing Address - Fax:714-994-2510
Practice Address - Street 1:5861 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2021
Practice Address - Country:US
Practice Address - Phone:714-994-2501
Practice Address - Fax:714-994-2510
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics