MEDICARE: HEIVI KIM WESTERN DDS INC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1518823889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEIVI KIM WESTERN DDS INC

Provider Business Mailing Address
First Line	:	1726 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5804
Country	:	US
Telephone Number	:	213-718-0811
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HEIVI KIM
Credential	:	DDS
Telephone Number	:	213-718-0811

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	12/31/2025

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