Provider Demographics
NPI:1154591410
Name:KIM, DAVID S (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
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 1:25078 PEACHLAND AVE.
Mailing Address - Street 2:#G
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2533
Mailing Address - Country:US
Mailing Address - Phone:661-255-0220
Mailing Address - Fax:661-255-9577
Practice Address - Street 1:25078 PEACHLAND AVE
Practice Address - Street 2:#G
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2533
Practice Address - Country:US
Practice Address - Phone:661-255-0220
Practice Address - Fax:661-255-9577
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist