Healthcare Provider Details

I. General information

NPI: 1659296689
Provider Name (Legal Business Name): HYUN IL KIM DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DR CARREON BLVD STE B
INDIO CA
92201-5594
US

IV. Provider business mailing address

81812 DR CARREON BLVD STE B
INDIO CA
92201-5594
US

V. Phone/Fax

Practice location:
  • Phone: 760-296-1865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HYUN IL KIM
Title or Position: PRESIDENT
Credential:
Phone: 909-219-3567