Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 048958 | NY |
N | 122300000X | Dentist | 18525 | FL |
N | 122300000X | Dentist | 21262 | NJ |
Y | 122300000X | Dentist | 64083 | CA |
N | 1223P0700X | Prosthodontist | 5289 | NJ |
NPI | 1174690416 |
---|---|
Provider Name | Dr. Hyun Yil Henry Kim |
First Address | Mission Viejo, CA 92691-6727 |
Second Address | Mission Viejo, CA 92691-6727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 11/11/2015 |