Provider Demographics
NPI:1285206227
Name:KIM, WILLIAM WOO KYEOM (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WOO KYEOM
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 SUNSET PL
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4558
Mailing Address - Country:US
Mailing Address - Phone:909-525-3883
Mailing Address - Fax:
Practice Address - Street 1:82151 AVENUE 42 STE 110
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-9313
Practice Address - Country:US
Practice Address - Phone:176-025-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist