Provider Demographics
NPI:1265784003
Name:KIM, BYUNGWOOK
Entity type:Individual
Prefix:DR
First Name:BYUNGWOOK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1007 W LA PALMA AVE
Mailing Address - Street 2:#2
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1007 W LA PALMA AVE STE 2
Practice Address - Street 2:#2
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3620
Practice Address - Country:US
Practice Address - Phone:213-235-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice