Provider Demographics
NPI:1700277407
Name:KIM, JOHN SEONG (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SEONG
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:SEONG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5001 CERRITOS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4570
Mailing Address - Country:US
Mailing Address - Phone:714-821-6171
Mailing Address - Fax:714-821-0230
Practice Address - Street 1:5001 CERRITOS AVE STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4570
Practice Address - Country:US
Practice Address - Phone:714-821-6171
Practice Address - Fax:714-821-0230
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1007201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice