Provider Demographics
NPI:1114332046
Name:KIM, DUG SOO (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUG SOO
Middle Name:
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 1:27087 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3213
Mailing Address - Country:US
Mailing Address - Phone:440-471-4098
Mailing Address - Fax:440-276-8755
Practice Address - Street 1:27087 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3213
Practice Address - Country:US
Practice Address - Phone:440-471-4098
Practice Address - Fax:440-276-8755
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0242731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice