Provider Demographics
NPI:1992893473
Name:KIM, ROBERT C (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE B124
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1704
Mailing Address - Country:US
Mailing Address - Phone:858-457-3610
Mailing Address - Fax:858-457-4025
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE B124
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1704
Practice Address - Country:US
Practice Address - Phone:858-457-3610
Practice Address - Fax:858-457-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA466231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice