Provider Demographics
NPI:1043424864
Name:KIM-MORRIS, SUSAN JIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JIN
Last Name:KIM-MORRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-3414
Mailing Address - Country:US
Mailing Address - Phone:610-384-5349
Mailing Address - Fax:
Practice Address - Street 1:538 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3414
Practice Address - Country:US
Practice Address - Phone:610-384-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0289131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA223412768Medicaid
NJ6514707Medicaid