Provider Demographics
NPI:1619353208
Name:BRIAN D KIM DDS INC
Entity Type:Organization
Organization Name:BRIAN D KIM DDS INC
Other - Org Name:BRIAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-680-4707
Mailing Address - Street 1:25211 PASEO DE ALICIA # 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4614
Mailing Address - Country:US
Mailing Address - Phone:949-680-4707
Mailing Address - Fax:949-680-4708
Practice Address - Street 1:25211 PASEO DE ALICIA # 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4614
Practice Address - Country:US
Practice Address - Phone:949-680-4707
Practice Address - Fax:949-680-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty