Provider Demographics
NPI:1336546514
Name:SUSAN HAE SUK KIM DDS INC
Entity type:Organization
Organization Name:SUSAN HAE SUK KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAE SUK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-448-3976
Mailing Address - Street 1:1301 S BEACH BLVD
Mailing Address - Street 2:UNIT G
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6384
Mailing Address - Country:US
Mailing Address - Phone:562-448-3976
Mailing Address - Fax:
Practice Address - Street 1:1301 S BEACH BLVD
Practice Address - Street 2:UNIT G
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6384
Practice Address - Country:US
Practice Address - Phone:951-790-7496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty