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General NPI Number Information
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NPI Number | 1669901690
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Entity Type | Individual
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Provider Name | HYE SUNG KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2017
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 8035 S RAINBOW BLVD STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89139-6549
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Country | US
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Telephone | 702-896-7211
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 BROADWAY
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City | GARY
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State | IN
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Zip | 46407
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Country | US
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Telephone | 219-616-6809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12012878B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-367
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License Number State | NV
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