MEDICARE: DR. JIMMY HYON KU D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	60962	CA
2	122300000X	Dentist	60962	CA

General Provider Information

NPI Number	:	1629357843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY HYON KU D.D.S.

Provider Business Mailing Address
First Line	:	9971 AVENIDA MAGNIFICA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1423
Country	:	US
Telephone Number	:	808-445-8797
Fax Number	:

Provider Business Practice Location Address
First Line	:	10TH STREET, BUILDING 22190
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058
Country	:	US
Telephone Number	:	760-725-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	06/16/2026

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