Healthcare Provider Details

I. General information

NPI: 1639091093
Provider Name (Legal Business Name): EVAN HYUNWU KIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29121 S WESTERN AVE
RANCHO PALOS VERDES CA
90275-1125
US

IV. Provider business mailing address

1050 S FLOWER ST APT 334
LOS ANGELES CA
90015-5105
US

V. Phone/Fax

Practice location:
  • Phone: 310-594-7338
  • Fax:
Mailing address:
  • Phone: 425-512-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: