Provider Demographics
NPI:1649393174
Name:KIM, JI HYUN (DDS)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 HERCULES AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2722
Mailing Address - Country:US
Mailing Address - Phone:281-218-8400
Mailing Address - Fax:281-486-0824
Practice Address - Street 1:1066 HERCULES AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2722
Practice Address - Country:US
Practice Address - Phone:281-218-8400
Practice Address - Fax:281-486-0824
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist