Provider Demographics
NPI:1538338249
Name:KIM, GEE H (DDS, MAGD)
Entity type:Individual
Prefix:DR
First Name:GEE
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:GEEHONG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MAGD
Mailing Address - Street 1:4428 CONVOY ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3761
Mailing Address - Country:US
Mailing Address - Phone:858-573-2833
Mailing Address - Fax:
Practice Address - Street 1:4428 CONVOY ST STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3761
Practice Address - Country:US
Practice Address - Phone:858-573-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice