Provider Demographics
NPI:1811054646
Name:KIM, MYRON SEYMIN (DDS)
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:SEYMIN
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 1:18107 SHERMAN WAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335
Mailing Address - Country:US
Mailing Address - Phone:818-345-0007
Mailing Address - Fax:818-345-1360
Practice Address - Street 1:18107 SHERMAN WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335
Practice Address - Country:US
Practice Address - Phone:818-345-0007
Practice Address - Fax:818-345-1360
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist