Provider Demographics
NPI:1841475761
Name:KIM, SAVANNAH J (DDS)
Entity type:Individual
Prefix:DR
First Name:SAVANNAH
Middle Name:J
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 1:10810 N TATUM BLVD STE 102-766
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6055
Mailing Address - Country:US
Mailing Address - Phone:650-293-7090
Mailing Address - Fax:
Practice Address - Street 1:531 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4549
Practice Address - Country:US
Practice Address - Phone:475-313-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56483122300000X
CT145431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice