Healthcare Provider Details

I. General information

NPI: 1144148701
Provider Name (Legal Business Name): HYE RI KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W MARKET ST
NEWARK NJ
07103-2765
US

IV. Provider business mailing address

180 W MARKET ST
NEWARK NJ
07103-2765
US

V. Phone/Fax

Practice location:
  • Phone: 347-818-7683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03165200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: