Provider Demographics
NPI:1073601480
Name:KIM, KYEONGSEON (DDS)
Entity Type:Individual
Prefix:
First Name:KYEONGSEON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W UNIVERSITY DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069
Mailing Address - Country:US
Mailing Address - Phone:972-547-0066
Mailing Address - Fax:972-547-0069
Practice Address - Street 1:1717 W UNIVERSITY DR STE410
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:972-547-0066
Practice Address - Fax:972-547-0069
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice