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Provider Information for 1811413594

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Other Name:   YONGHYUN KIM
Gender: MALE

Individual NPI: 1811413594

Calendar   Last Updated:  2019-04-25
  Certification Date: 


Name Value
NPI 1811413594
Enumeration Date 2017-08-15
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 16213 STAR CREST WAY
FONTANA, CA 92336-1472
United States

Phone: 909-275-1626 | Fax:
View Map External Link
Primary Practice Address 1508 N RIVERSIDE DR
ESPANOLA, NM 87532-2064
United States

Phone: 505-753-0544 | Fax:
View Map External Link
Secondary Practice Address 8400 OSUNA RD NE STE 5A
ALBUQUERQUE, NM 87111-2072
United States

Phone: 505-884-1989 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NM DD4781