Provider Demographics
NPI:1588837801
Name:KIM, JAEHONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAEHONG
Middle Name:
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 1:113 WATERWORKS WAY STE 335
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3173
Mailing Address - Country:US
Mailing Address - Phone:949-502-3313
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 335
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3173
Practice Address - Country:US
Practice Address - Phone:949-502-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist