Provider Demographics
NPI:1386726743
Name:KIM, ALEXANDER THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 BRIDGEPOINTE PKWY APT 214
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-5004
Mailing Address - Country:US
Mailing Address - Phone:646-642-2256
Mailing Address - Fax:
Practice Address - Street 1:485 34TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2823
Practice Address - Country:US
Practice Address - Phone:510-547-7668
Practice Address - Fax:510-547-7668
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics