Provider Demographics
NPI:1982749974
Name:KIM, JOSEPH K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:K
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 1:800 N TUSTIN AVE STE L
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3605
Mailing Address - Country:US
Mailing Address - Phone:714-836-8200
Mailing Address - Fax:714-836-4758
Practice Address - Street 1:800 N TUSTIN AVE STE L
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3605
Practice Address - Country:US
Practice Address - Phone:714-836-8200
Practice Address - Fax:714-836-4758
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice