Provider Demographics
NPI:1497930457
Name:KIM, HYUN WOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:HYUN
Middle Name:WOO
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 1:25030 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
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-05-26
Deactivation Date:2021-04-19
Deactivation Code:
Reactivation Date:2021-05-10
Provider Licenses
StateLicense IDTaxonomies
CA56711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist