Individual
MR. KWANG JIN KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
3300 W ROSECRANS AVE, SUITE 105, HAWTHORNE, CA 90250-8218
(310) 679-3300
(310) 679-3932
Mailing address
2220 SMOKEWOOD AVE, FULLERTON, CA 92831-1107
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
31300
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B-31300-02
MEDICAL PROVIDER NUMBER
CA
Enumeration date
01/08/2007
Last updated
07/08/2007
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