Provider Demographics
NPI:1851863393
Name:KWANG SEOB KIM DDS INC
Entity Type:Organization
Organization Name:KWANG SEOB KIM DDS INC
Other - Org Name:CALIFORNIA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:SEOB
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-403-8818
Mailing Address - Street 1:12309 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1603
Mailing Address - Country:US
Mailing Address - Phone:562-403-8818
Mailing Address - Fax:562-403-1024
Practice Address - Street 1:12309 CARSON ST
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1603
Practice Address - Country:US
Practice Address - Phone:562-403-8818
Practice Address - Fax:562-403-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty