Provider Demographics
NPI:1669524153
Name:KIM, JIN-HYUK (DDS)
Entity type:Individual
Prefix:DR
First Name:JIN-HYUK
Middle Name:
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 1:14238 VALLEY CENTER DR
Mailing Address - Street 2:#104
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4279
Mailing Address - Country:US
Mailing Address - Phone:760-243-5437
Mailing Address - Fax:760-243-2313
Practice Address - Street 1:14238 VALLEY CENTER DR
Practice Address - Street 2:#104
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4279
Practice Address - Country:US
Practice Address - Phone:760-243-5437
Practice Address - Fax:760-243-2313
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice