Provider Demographics
NPI:1093017956
Name:KIM, SAE KYU (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAE
Middle Name:KYU
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 GLIDEWELL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8253
Mailing Address - Country:US
Mailing Address - Phone:336-524-0099
Mailing Address - Fax:
Practice Address - Street 1:1595 GLIDEWELL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8253
Practice Address - Country:US
Practice Address - Phone:336-524-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice