Provider Demographics
NPI:1750455689
Name:KIM, YONGHWAN (DDS)
Entity type:Individual
Prefix:
First Name:YONGHWAN
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 1:50 S. ANAHEIM BLVD
Mailing Address - Street 2:SUITE 94
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805
Mailing Address - Country:US
Mailing Address - Phone:949-543-4383
Mailing Address - Fax:253-856-3387
Practice Address - Street 1:50 S. ANAHEIM BLVD
Practice Address - Street 2:SUITE 94
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805
Practice Address - Country:US
Practice Address - Phone:714-635-5500
Practice Address - Fax:253-856-3387
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61241122300000X
WADE00009083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist