Provider Demographics
NPI:1881832806
Name:KIM, STEPHEN CHUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3811 BEDFORD CANYON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0789
Mailing Address - Country:US
Mailing Address - Phone:951-270-0211
Mailing Address - Fax:951-270-0702
Practice Address - Street 1:3811 BEDFORD CANYON RD STE 105
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0789
Practice Address - Country:US
Practice Address - Phone:951-270-0211
Practice Address - Fax:951-270-0702
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA514851223X0400X
CO96181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics