Provider Demographics
NPI:1750478582
Name:KIM, STEVEN S (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
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 1:2983 CHINO AVE STE A5
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3576
Mailing Address - Country:US
Mailing Address - Phone:909-628-7000
Mailing Address - Fax:909-628-6039
Practice Address - Street 1:2983 CHINO AVE STE A5
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3576
Practice Address - Country:US
Practice Address - Phone:909-628-7000
Practice Address - Fax:909-628-6039
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 313021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice