Healthcare Provider Details

I. General information

NPI: 1255856191
Provider Name (Legal Business Name): KYIM MUNG DDS, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 W 8TH ST STE 103
HANFORD CA
93230-4533
US

IV. Provider business mailing address

833 GREENFIELD AVE STE 105
HANFORD CA
93230-3673
US

V. Phone/Fax

Practice location:
  • Phone: 559-587-2505
  • Fax: 559-587-2510
Mailing address:
  • Phone: 951-531-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS101778
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number101778
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number101778
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number37641
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: