Provider Demographics
NPI:1962893255
Name:KIM, BRYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26440 LA ALAMEDA STE 320
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6304
Mailing Address - Country:US
Mailing Address - Phone:949-445-1234
Mailing Address - Fax:949-445-1337
Practice Address - Street 1:26440 LA ALAMEDA STE 320
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6304
Practice Address - Country:US
Practice Address - Phone:949-445-1234
Practice Address - Fax:949-445-1337
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS642431223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain