Healthcare Provider Details

I. General information

NPI: 1265976328
Provider Name (Legal Business Name): HYE H KIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 INNER LOOP RD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

390 NORTH LOOP RD
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-8062
  • Fax:
Mailing address:
  • Phone: 760-383-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: