Provider Demographics
NPI:1003230665
Name:KIM, JOON WON (DDS)
Entity Type:Individual
Prefix:
First Name:JOON
Middle Name:WON
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 1:4601 W 109TH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1318
Mailing Address - Country:US
Mailing Address - Phone:913-498-3636
Mailing Address - Fax:913-498-0935
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:913-498-3636
Practice Address - Fax:913-498-0935
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS72231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics