Healthcare Provider Details

I. General information

NPI: 1538576012
Provider Name (Legal Business Name): DOHYUN KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 28TH AVE
SAN MATEO CA
94403-2427
US

IV. Provider business mailing address

30 28TH AVE
SAN MATEO CA
94403-2427
US

V. Phone/Fax

Practice location:
  • Phone: 650-345-3903
  • Fax: 650-345-4406
Mailing address:
  • Phone: 650-345-3903
  • Fax: 650-345-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: