Provider Demographics
NPI:1538597729
Name:KIM, STELLA (DDS)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SANTIAGO ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1819
Mailing Address - Country:US
Mailing Address - Phone:415-566-3305
Mailing Address - Fax:415-566-3045
Practice Address - Street 1:800 SANTIAGO ST STE B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1819
Practice Address - Country:US
Practice Address - Phone:415-566-3305
Practice Address - Fax:415-566-3045
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice