Provider Demographics
NPI:1629498654
Name:KIM, HAE-JUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAE-JUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:307 MALL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5795
Mailing Address - Country:US
Mailing Address - Phone:559-585-1519
Mailing Address - Fax:559-380-2125
Practice Address - Street 1:307 MALL DR STE 101
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-585-1519
Practice Address - Fax:559-380-2125
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist