Provider Demographics
NPI:1912113598
Name:KIM, BERNARD EUGENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:EUGENE
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3825
Mailing Address - Country:US
Mailing Address - Phone:805-486-2396
Mailing Address - Fax:805-486-9607
Practice Address - Street 1:2184 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3825
Practice Address - Country:US
Practice Address - Phone:805-486-2396
Practice Address - Fax:805-486-9607
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist