Provider Demographics
NPI:1780188581
Name:KIM, CHAE HYUN (DDS)
Entity Type:Individual
Prefix:
First Name:CHAE
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:CHAE HYUN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1519 CORTE OLIVAS
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4006
Mailing Address - Country:US
Mailing Address - Phone:949-648-1923
Mailing Address - Fax:
Practice Address - Street 1:3760 W MCFADDEN AVE STE D
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1392
Practice Address - Country:US
Practice Address - Phone:657-231-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist