Provider Demographics
NPI:1841475761
Name:KIM, SAVANNAH J (DDS)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:J
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 1:8 DEER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3999
Mailing Address - Country:US
Mailing Address - Phone:408-329-2327
Mailing Address - Fax:
Practice Address - Street 1:2130 RALSTON AVE STE 1B
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1664
Practice Address - Country:US
Practice Address - Phone:650-591-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist