Provider Demographics
NPI:1134272362
Name:KIM, SUNG JOO C (DDS)
Entity type:Individual
Prefix:
First Name:SUNG JOO
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:S
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1855 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-693-3371
Mailing Address - Fax:714-526-4671
Practice Address - Street 1:1855 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-693-3371
Practice Address - Fax:714-526-4671
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2015-11-02
Deactivation Date:2015-11-02
Deactivation Code:
Reactivation Date:2015-11-02
Provider Licenses
StateLicense IDTaxonomies
CADA 035824122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35824 01OtherMEDICAL