Provider Demographics
NPI:1457527418
Name:KIM, JONATHAN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:H
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 1:1725 BERRYESSA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1173
Mailing Address - Country:US
Mailing Address - Phone:408-259-2900
Mailing Address - Fax:408-259-3073
Practice Address - Street 1:1725 BERRYESSA RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1173
Practice Address - Country:US
Practice Address - Phone:408-259-2900
Practice Address - Fax:408-259-3073
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA357451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice