Provider Demographics
NPI:1386054674
Name:SOYEON KIM
Entity type:Organization
Organization Name:SOYEON KIM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOYEON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-835-8797
Mailing Address - Street 1:2509 W MCFADDEN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2747
Mailing Address - Country:US
Mailing Address - Phone:714-835-8797
Mailing Address - Fax:714-835-8798
Practice Address - Street 1:2509 W MCFADDEN AVE
Practice Address - Street 2:SUITE-E
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2747
Practice Address - Country:US
Practice Address - Phone:714-835-8797
Practice Address - Fax:714-835-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546271223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty