Provider Demographics
NPI:1114505138
Name:KIM, PAUL SUNG JUN (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SUNG JUN
Last Name:KIM
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 GOODRICH BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4114
Mailing Address - Country:US
Mailing Address - Phone:818-306-7150
Mailing Address - Fax:303-343-0247
Practice Address - Street 1:972 GOODRICH BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-4114
Practice Address - Country:US
Practice Address - Phone:818-306-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1100951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program