Provider Demographics
NPI:1932309499
Name:KIM, HENRY HYUCK KUN (DDS)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:HYUCK KUN
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 1:5414 SUNRISE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7803
Mailing Address - Country:US
Mailing Address - Phone:916-967-9953
Mailing Address - Fax:916-966-9084
Practice Address - Street 1:5414 SUNRISE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7803
Practice Address - Country:US
Practice Address - Phone:916-967-9953
Practice Address - Fax:916-966-9084
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice