Provider Demographics
NPI:1700800943
Name:KIM, PILSEONG (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:PILSEONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 BARRANCA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4727
Mailing Address - Country:US
Mailing Address - Phone:949-654-4760
Mailing Address - Fax:949-654-4763
Practice Address - Street 1:4760 BARRANCA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4727
Practice Address - Country:US
Practice Address - Phone:949-654-4760
Practice Address - Fax:949-654-4763
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics