Provider Demographics
NPI:1134336324
Name:KIM, MINGI (DDS)
Entity type:Individual
Prefix:DR
First Name:MINGI
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 DAGGET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2235
Mailing Address - Country:US
Mailing Address - Phone:858-874-3000
Mailing Address - Fax:858-277-6661
Practice Address - Street 1:7750 DAGGET ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2235
Practice Address - Country:US
Practice Address - Phone:858-874-3000
Practice Address - Fax:858-277-6661
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice