Provider Demographics
NPI:1053595926
Name:AUSTIN, KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:AUSTIN
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 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:SUITE #500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-294-1170
Mailing Address - Fax:323-295-0286
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:SUITE #500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-294-1170
Practice Address - Fax:323-295-0286
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics