Provider Demographics
NPI:1164949798
Name:HYUN J KIM DENTAL CORPORATION
Entity Type:Organization
Organization Name:HYUN J KIM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O. / OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-344-1613
Mailing Address - Street 1:580 G ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2411
Mailing Address - Country:US
Mailing Address - Phone:760-344-1613
Mailing Address - Fax:
Practice Address - Street 1:580 G ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2411
Practice Address - Country:US
Practice Address - Phone:760-344-1613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty