Provider Demographics
NPI:1689198806
Name:SEUNG HWAN KIM, DDS, INC
Entity Type:Organization
Organization Name:SEUNG HWAN KIM, DDS, INC
Other - Org Name:PRIME DENTAL GROUP DR KIM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEUNG HWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-505-2088
Mailing Address - Street 1:13252 CENTURY BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1257
Mailing Address - Country:US
Mailing Address - Phone:714-591-5190
Mailing Address - Fax:
Practice Address - Street 1:13252 CENTURY BLVD STE Q
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1257
Practice Address - Country:US
Practice Address - Phone:714-591-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65350261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental