Provider Demographics
NPI:1689142648
Name:BRYAN KIM DDS INC
Entity Type:Organization
Organization Name:BRYAN KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-839-3685
Mailing Address - Street 1:26440 LA ALAMEDA STE 320
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6304
Mailing Address - Country:US
Mailing Address - Phone:949-445-1234
Mailing Address - Fax:949-445-1337
Practice Address - Street 1:26440 LA ALAMEDA STE 320
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6304
Practice Address - Country:US
Practice Address - Phone:949-445-1234
Practice Address - Fax:949-445-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental