Provider Demographics
NPI:1841206786
Name:KIM, BRIAN DAE-YONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAE-YONG
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 1:1580 MAKALOA ST
Mailing Address - Street 2:SUITE 535
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3291
Mailing Address - Country:US
Mailing Address - Phone:808-979-2875
Mailing Address - Fax:808-979-7575
Practice Address - Street 1:1580 MAKALOA ST
Practice Address - Street 2:SUITE 535
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3291
Practice Address - Country:US
Practice Address - Phone:808-979-2875
Practice Address - Fax:808-979-7575
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBK94365691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI543422-01Medicaid
HI0000244343OtherHMSA
HI8518OtherDELTA DENTAL
HI2055OtherHAWAII DENTAL SERVICE