Provider Demographics
NPI:1811071004
Name:KIM, NICHOLAS H (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
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 1:420 W PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-7516
Mailing Address - Country:US
Mailing Address - Phone:805-488-2221
Mailing Address - Fax:805-488-3025
Practice Address - Street 1:420 W PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-7516
Practice Address - Country:US
Practice Address - Phone:805-488-2221
Practice Address - Fax:805-488-3025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice