MEDICARE: LUCY HYOJOUNG KIM DMD

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356278220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY HYOJOUNG KIM DMD

Provider Business Mailing Address
First Line	:	975 LONGLEY AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-2358
Country	:	US
Telephone Number	:	408-637-9317
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 LONGLEY AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-2358
Country	:	US
Telephone Number	:	408-637-9317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1144294174 — DR. JUSTIN A D'ARIENZO PSY.D., ABPP
Practice Location Address:

6058 SAN JOSE BLVD
JACKSONVILLE, FL
32217-2358

Practice Phone: 904-379-8094
Practice Fax: 904-379-8688

1972701522 — MISS ERICA LAUREN JANSON PSYD
Practice Location Address:

6058 SAN JOSE BLVD
JACKSONVILLE, FL
32217-2358

Practice Phone: 860-539-3651
Practice Fax:

1508259920 — DR. MICHAEL AMER NACKASHI PSY.D.
Practice Location Address:

6058 SAN JOSE BLVD
JACKSONVILLE, FL
32217-2358

Practice Phone: 904-379-8094
Practice Fax:

1215788450 — MIAMOR GUTIERREZ
Practice Location Address:

3316 BEL MIRA WAY
SAN JOSE, CA
95135-2358

Practice Phone: 408-661-1994
Practice Fax:

1477603983 — EPEIUS BIOTECHNOLOGIES CORPORATION
Practice Location Address:

475 HUNTINGTON DR
SAN MARINO, CA
91108-2358

Practice Phone: 626-441-6695
Practice Fax: 626-441-6692

Directions to “ LUCY HYOJOUNG KIM DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.