Provider Demographics
NPI:1114391562
Name:HYUNYIL HENRY KIM DMD PC
Entity Type:Organization
Organization Name:HYUNYIL HENRY KIM DMD PC
Other - Org Name:HENRY KIM DMD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUNYIL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-252-3981
Mailing Address - Street 1:25982 PALA STE 200
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6727
Mailing Address - Country:US
Mailing Address - Phone:949-472-5499
Mailing Address - Fax:
Practice Address - Street 1:25982 PALA STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6727
Practice Address - Country:US
Practice Address - Phone:949-472-5499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640831223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty