Provider Demographics
NPI:1700910536
Name:KIM, SI-HYUN SY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SI-HYUN
Middle Name:SY
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 1:87 SCRIPPS DR STE 314
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6318
Mailing Address - Country:US
Mailing Address - Phone:916-487-5032
Mailing Address - Fax:
Practice Address - Street 1:87 SCRIPPS DR STE 314
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6318
Practice Address - Country:US
Practice Address - Phone:916-487-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist