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General NPI Number Information
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NPI Number | 1164949798
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Entity Type | Organization
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Legal Business Name | HYUN J KIM DENTAL CORPORATION
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 580 G ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2411
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Country | US
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Telephone | 760-344-1613
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Fax |
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Provider Business Mailing Address
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Address Line | 580 G ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2411
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Country | US
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Telephone | 760-344-1613
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Fax |
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Authorized Official
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Title or Position | C.E.O. / OWNER DENTIST
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Name | HYUN JUNE KIM
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Credential | DDS
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Telephone | 760-344-1613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54986
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License Number State | CA
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