Provider Demographics
NPI:1104094580
Name:KIM, INSOO (DDS)
Entity type:Individual
Prefix:DR
First Name:INSOO
Middle Name:
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 1:8350 LOS COYOTES DR
Mailing Address - Street 2:#A
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1073
Mailing Address - Country:US
Mailing Address - Phone:714-522-5565
Mailing Address - Fax:714-522-5758
Practice Address - Street 1:8350 LOS COYOTES DR
Practice Address - Street 2:#A
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1073
Practice Address - Country:US
Practice Address - Phone:714-522-5565
Practice Address - Fax:714-522-5758
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist