Provider Demographics
NPI:1134215668
Name:KIM, RONALD C (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7301 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1782
Mailing Address - Country:US
Mailing Address - Phone:818-997-0315
Mailing Address - Fax:818-997-0316
Practice Address - Street 1:7301 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1782
Practice Address - Country:US
Practice Address - Phone:818-997-0315
Practice Address - Fax:818-997-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice