Provider Demographics
NPI:1740403559
Name:KIM, RICHARD YONGYUP (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:YONGYUP
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 1:95-1050 MAKAIKAI ST APT 8K
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4318
Mailing Address - Country:US
Mailing Address - Phone:213-550-3530
Mailing Address - Fax:
Practice Address - Street 1:1838 S 15TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204
Practice Address - Country:US
Practice Address - Phone:414-455-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2535122300000X
CA41631122300000X
IL019.031953122300000X
WI1001209-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist