Provider Demographics
NPI:1174690416
Name:KIM, HYUN YIL HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HYUN YIL
Middle Name:HENRY
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
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:949-472-0948
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:949-472-0948
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21262122300000X
NY048958122300000X
NJ52891223P0700X
FL18525122300000X
CA64083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics