Provider Demographics
NPI:1538576012
Name:KIM, DOHYUN (DMD)
Entity type:Individual
Prefix:
First Name:DOHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6399 CHRISTIE AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2710 TELEGRAPH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1770
Practice Address - Country:US
Practice Address - Phone:510-839-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist