Provider Demographics
NPI:1649406240
Name:KIM, HOUN YOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:HOUN
Middle Name:YOUNG
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 1:1720 MARCO POLO WAY STE D
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4513
Mailing Address - Country:US
Mailing Address - Phone:650-417-5032
Mailing Address - Fax:
Practice Address - Street 1:1720 MARCO POLO WAY STE D
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4513
Practice Address - Country:US
Practice Address - Phone:650-417-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice