Provider Demographics
NPI:1366592842
Name:KIM, JI-HYUN (DDS)
Entity type:Individual
Prefix:DR
First Name:JI-HYUN
Middle Name:
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 1:4042 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8401
Mailing Address - Country:US
Mailing Address - Phone:559-363-1409
Mailing Address - Fax:
Practice Address - Street 1:1404 N BEN MADDOX WAY
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-2246
Practice Address - Country:US
Practice Address - Phone:559-741-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1402304OtherUNITED CONCORDIA
CAG92150-14OtherGOVERNMENT STATE PROGRAM
CAG92150-14OtherDENTICAL