Provider Demographics
NPI:1215184072
Name:BRIAN D KIM DDS INC
Entity type:Organization
Organization Name:BRIAN D KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-730-8070
Mailing Address - Street 1:12721 NEWPORT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-8031
Mailing Address - Country:US
Mailing Address - Phone:714-730-8070
Mailing Address - Fax:714-730-8112
Practice Address - Street 1:12721 NEWPORT AVE STE 1
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8031
Practice Address - Country:US
Practice Address - Phone:714-730-8070
Practice Address - Fax:714-730-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty