Provider Demographics
NPI:1639365307
Name:KIM, HWA YOUN (DDS)
Entity Type:Individual
Prefix:
First Name:HWA YOUN
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 1:3307 ALTA ARDEN EXPY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2102
Mailing Address - Country:US
Mailing Address - Phone:916-974-1819
Mailing Address - Fax:916-974-7568
Practice Address - Street 1:3307 ALTA ARDEN EXPY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2102
Practice Address - Country:US
Practice Address - Phone:916-974-1819
Practice Address - Fax:916-974-7568
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice