Provider Demographics
NPI:1851415566
Name:KIM, ALEXANDER Y (DDS MS)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 MONTPELIER DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1612
Mailing Address - Country:US
Mailing Address - Phone:408-272-1272
Mailing Address - Fax:408-272-1289
Practice Address - Street 1:2324 MONTPELIER DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1612
Practice Address - Country:US
Practice Address - Phone:408-272-1272
Practice Address - Fax:408-272-1289
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist