Healthcare Provider Details

I. General information

NPI: 1790356038
Provider Name (Legal Business Name): JOHNATHAN HYUN KIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 ORANGE TREE LN STE 101
REDLANDS CA
92374-0112
US

IV. Provider business mailing address

61 DONOVAN
IRVINE CA
92620-3882
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-5270
  • Fax:
Mailing address:
  • Phone: 909-279-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number106446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: