Provider Demographics
NPI:1871541540
Name:KIM, KYUNG MYUN (DDS)
Entity type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:MYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13132 NEWPORT AVE
Mailing Address - Street 2:SUITE # 220
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3429
Mailing Address - Country:US
Mailing Address - Phone:714-505-2010
Mailing Address - Fax:714-505-2011
Practice Address - Street 1:13132 NEWPORT AVE
Practice Address - Street 2:SUITE # 220
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3429
Practice Address - Country:US
Practice Address - Phone:714-505-2010
Practice Address - Fax:714-505-2011
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA202693132OtherTAX ID NUMBER