| Brian D Kim DDS Inc | |
|
12721 Newport Ave Ste 1 Tustin CA 92780-8031 | |
| (714) 730-8070 | |
| (714) 730-8112 |
| Full Name | Brian D Kim DDS Inc |
|---|---|
| Speciality | Dentist |
| Location | 12721 Newport Ave Ste 1, Tustin, California |
| Authorized Official Name and Position | Brian Kim (DENTIST/OWNER) |
| Authorized Official Contact | 7147308070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian D Kim DDS Inc 12721 Newport Ave Ste 1 Tustin CA 92780-8031 Ph: (714) 730-8070 | Brian D Kim DDS Inc 12721 Newport Ave Ste 1 Tustin CA 92780-8031 Ph: (714) 730-8070 |
| NPI Number | 1215184072 |
|---|---|
| Provider Enumeration Date | 08/25/2008 |
| Last Update Date | 10/08/2025 |
| Certification Date | 10/08/2025 |
| Medicare PECOS PAC ID | 9638399363 |
|---|---|
| Medicare Enrollment ID | O20141001001557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215184072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 50765 (California) | Secondary |
| 1223G0001X | Dentist - General Practice | () | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | () | Secondary |
| Provider Name | Brian D Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1598989063 PECOS PAC ID: 2163642893 Enrollment ID: I20141001002131 |
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