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NPI Code Detail

MEDICARE: DR. KWANG HYEON KIM

MEDICARE: DR. KWANG HYEON KIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry107101CA

General Provider Information

NPI Number : 1104581305
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KWANG HYEON KIM
Provider Business Mailing Address
First Line : 1100 WEBSTER ST APT 279
Second Line :
City : OAKLAND
State : CA
Zip : 94607-4198
Country : US
Telephone Number : 206-775-2701
Fax Number :
Provider Business Practice Location Address
First Line : 3779 E CASTRO VALLEY BLVD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94552-4835
Country : US
Telephone Number : 510-581-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2021
Last Update Date : 11/02/2021

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Directions to “ DR. KWANG HYEON KIM ” Practice Location

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