Provider Demographics
NPI:1255856191
Name:MUNG, KYIM (DDS, MA)
Entity Type:Individual
Prefix:DR
First Name:KYIM
Middle Name:
Last Name:MUNG
Suffix:
Gender:F
Credentials:DDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9626 DIAMOND GAP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6758
Mailing Address - Country:US
Mailing Address - Phone:951-531-3255
Mailing Address - Fax:
Practice Address - Street 1:6820 ALAMO PKWY STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6595
Practice Address - Country:US
Practice Address - Phone:210-951-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1017781223G0001X
CA101778390200000X
TX376411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program