Provider Demographics
NPI:1184872624
Name:KIM, SEOHEE A
Entity type:Individual
Prefix:
First Name:SEOHEE
Middle Name:A
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S OAKHURST DR
Mailing Address - Street 2:103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3525
Mailing Address - Country:US
Mailing Address - Phone:310-849-6194
Mailing Address - Fax:
Practice Address - Street 1:129 S OAKHURST DR
Practice Address - Street 2:103
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3525
Practice Address - Country:US
Practice Address - Phone:310-849-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice