Provider Demographics
NPI:1003293077
Name:KIM, CHRIS S (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 METAIRIE HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-3037
Mailing Address - Country:US
Mailing Address - Phone:858-740-0706
Mailing Address - Fax:
Practice Address - Street 1:1100 FLORIDA AVE RM 5303
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2715
Practice Address - Country:US
Practice Address - Phone:858-740-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX382471223G0001X
GADN0151061223G0001X
LA71151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice