Provider Demographics
NPI:1073828620
Name:KIM, HELEN HAEWON (DDS)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:HAEWON
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 1:6601 LYNDALE AVE. S.
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423
Mailing Address - Country:US
Mailing Address - Phone:612-866-1234
Mailing Address - Fax:612-638-1232
Practice Address - Street 1:6601 LYNDALE AVE. S. SUITE 230
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4843
Practice Address - Country:US
Practice Address - Phone:612-866-1234
Practice Address - Fax:612-638-1232
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202801223G0001X
MND13627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice