Provider Demographics
NPI:1710029574
Name:KIM, LUKE (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 AVENIDA DE CORTEZ
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2126
Mailing Address - Country:US
Mailing Address - Phone:310-600-9777
Mailing Address - Fax:310-581-8327
Practice Address - Street 1:1435 AVENIDA DE CORTEZ
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2126
Practice Address - Country:US
Practice Address - Phone:310-600-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice