Provider Demographics
NPI:1942496963
Name:KIM, JENNIFER HYUNJOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HYUNJOO
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 1:7212 REGIONAL ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2326
Mailing Address - Country:US
Mailing Address - Phone:925-829-8182
Mailing Address - Fax:925-829-8186
Practice Address - Street 1:7212 REGIONAL ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2326
Practice Address - Country:US
Practice Address - Phone:925-829-8182
Practice Address - Fax:925-829-8186
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist