Sang Woo Kim

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

103541 Issued in CA

Practice address

410 S Glendora Ave Ste 220
Glendora, CA 91741-6207

Phone

(626) 914-4587

NPI assigned

Apr 22, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1861889347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 S GLENDORA AVE STE 220",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917416207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S GLENDORA AVE STE 220",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917416207",
            "telephone_number": "626-914-4587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5323 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753903552",
            "country_code": "US",
            "telephone_number": "214-590-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SANG WOO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-22",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "103541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Kim
• David Y Kim, PA-C
• Grace Kim, PH.D.
• Grace Mijin Kim, DDS
• Myong-Su Jeffrey Kim
• Kimberlee Mendoza Marriage and Family Therapy
• Karen Anne Kimmons
• Lisa H Kimpark, M.D.
• Kislinger Eye Services Inc
• Mark B Kislinger, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Glendora, CA
• Providers in Glendora, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.