Provider Demographics
NPI:1093495392
Name:KIM, JOSHUA MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:MARK
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W VAN BUREN ST APT 2507
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-0103
Mailing Address - Country:US
Mailing Address - Phone:407-756-8098
Mailing Address - Fax:
Practice Address - Street 1:1035 W VAN BUREN ST APT 2507
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-0103
Practice Address - Country:US
Practice Address - Phone:407-756-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0342151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice