Provider Demographics
NPI:1295389815
Name:HYUN W KIM DDS INC
Entity Type:Organization
Organization Name:HYUN W KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-924-0993
Mailing Address - Street 1:25030 ALESSANDRO BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4383
Mailing Address - Country:US
Mailing Address - Phone:951-924-0993
Mailing Address - Fax:951-247-9693
Practice Address - Street 1:25030 ALESSANDRO BLVD STE D
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4383
Practice Address - Country:US
Practice Address - Phone:951-924-0993
Practice Address - Fax:951-247-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental