Provider Demographics
NPI:1740461417
Name:KIM, HAESUNG (DDS)
Entity type:Individual
Prefix:
First Name:HAESUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E LINCOLN AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3202
Mailing Address - Country:US
Mailing Address - Phone:714-535-0192
Mailing Address - Fax:714-535-7494
Practice Address - Street 1:101 E LINCOLN AVE
Practice Address - Street 2:STE. 100
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3202
Practice Address - Country:US
Practice Address - Phone:714-535-0192
Practice Address - Fax:714-535-7494
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice