Provider Demographics
NPI:1609219294
Name:JOHN HYUNYOUNG KIM, DDS, INC.
Entity Type:Organization
Organization Name:JOHN HYUNYOUNG KIM, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HYUNYOUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-748-3722
Mailing Address - Street 1:19742 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2432
Mailing Address - Country:US
Mailing Address - Phone:949-748-3722
Mailing Address - Fax:949-502-8855
Practice Address - Street 1:19742 MACARTHUR BLVD
Practice Address - Street 2:SUITE 224
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2432
Practice Address - Country:US
Practice Address - Phone:949-748-3722
Practice Address - Fax:949-502-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty