Provider Demographics
NPI:1841689932
Name:KIM, DAVID JOON (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOON
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 1:19333 BEAR VALLEY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-5150
Mailing Address - Country:US
Mailing Address - Phone:760-247-4155
Mailing Address - Fax:760-247-4955
Practice Address - Street 1:19333 BEAR VALLEY RD STE 205
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5150
Practice Address - Country:US
Practice Address - Phone:760-247-4155
Practice Address - Fax:760-247-4955
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist