Provider Demographics
NPI:1770826448
Name:KIM, HYUNG GUEN (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:HYUNG
Middle Name:GUEN
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 QUAIL LAKES DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5258
Mailing Address - Country:US
Mailing Address - Phone:209-235-7207
Mailing Address - Fax:209-235-7210
Practice Address - Street 1:4637 QUAIL LAKES DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5258
Practice Address - Country:US
Practice Address - Phone:209-235-7207
Practice Address - Fax:209-235-7210
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist