Provider Demographics
NPI:1033262274
Name:DR. DAVID KIM'S DENTAL OFFICE
Entity Type:Organization
Organization Name:DR. DAVID KIM'S DENTAL OFFICE
Other - Org Name:DAVID TAE KIM, D.D.S.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-762-7006
Mailing Address - Street 1:16114 NORTHERN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1633
Mailing Address - Country:US
Mailing Address - Phone:718-762-7006
Mailing Address - Fax:718-445-4518
Practice Address - Street 1:16114 NORTHERN BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1633
Practice Address - Country:US
Practice Address - Phone:718-762-7006
Practice Address - Fax:718-445-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040283-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty