Provider Demographics
NPI:1285888610
Name:KIM, THOMAS SUNGWHAN (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SUNGWHAN
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 1:940 CREEK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6974
Mailing Address - Country:US
Mailing Address - Phone:818-687-4031
Mailing Address - Fax:
Practice Address - Street 1:940 CREEK VIEW LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6974
Practice Address - Country:US
Practice Address - Phone:818-687-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist