Provider Demographics
NPI:1407957954
Name:KIM, HEEJOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEEJOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E LAS TUNAS DR
Mailing Address - Street 2:SUITE #7
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1411
Mailing Address - Country:US
Mailing Address - Phone:626-285-1159
Mailing Address - Fax:626-286-0251
Practice Address - Street 1:206 E LAS TUNAS DR
Practice Address - Street 2:SUITE #7
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1411
Practice Address - Country:US
Practice Address - Phone:626-285-1159
Practice Address - Fax:626-286-0251
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice