Provider Demographics
NPI:1356513683
Name:KIM, HYE YOUNG AHN (DDS)
Entity type:Individual
Prefix:
First Name:HYE
Middle Name:YOUNG AHN
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HYE
Other - Middle Name:YOUNG
Other - Last Name:AHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3530 ATLANTIC AVE
Mailing Address - Street 2:STE. 103
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4569
Mailing Address - Country:US
Mailing Address - Phone:562-988-2700
Mailing Address - Fax:
Practice Address - Street 1:3530 ATLANTIC AVE
Practice Address - Street 2:STE. 103
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4569
Practice Address - Country:US
Practice Address - Phone:562-988-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice