Provider Demographics
NPI:1457891327
Name:INSOO KIM DDS INC
Entity Type:Organization
Organization Name:INSOO KIM DDS INC
Other - Org Name:BEAUTIFUL SMILE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDNT
Authorized Official - Prefix:
Authorized Official - First Name:INSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-522-5565
Mailing Address - Street 1:4600 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1132
Mailing Address - Country:US
Mailing Address - Phone:714-522-5565
Mailing Address - Fax:714-522-5758
Practice Address - Street 1:4600 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1132
Practice Address - Country:US
Practice Address - Phone:714-522-5565
Practice Address - Fax:714-522-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30377261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104094580OtherPERSONAL NPI