Provider Demographics
NPI:1174958516
Name:HYEONG C. KIM, DDS, PHD, P.C.
Entity type:Organization
Organization Name:HYEONG C. KIM, DDS, PHD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HYEONG
Authorized Official - Middle Name:CHAN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:718-565-5445
Mailing Address - Street 1:9101 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3849
Mailing Address - Country:US
Mailing Address - Phone:718-565-5445
Mailing Address - Fax:718-565-0952
Practice Address - Street 1:9101 63RD DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3849
Practice Address - Country:US
Practice Address - Phone:718-565-5445
Practice Address - Fax:718-565-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055881-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty