Provider Demographics
NPI:1134293392
Name:KIM, CHRIS UNSOK (DMD)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:UNSOK
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 1:516 N ROLLING RD STE 207
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4187
Mailing Address - Country:US
Mailing Address - Phone:617-504-5063
Mailing Address - Fax:781-595-9013
Practice Address - Street 1:516 N ROLLING RD STE 207
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4187
Practice Address - Country:US
Practice Address - Phone:617-504-5063
Practice Address - Fax:781-595-9013
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0202169Medicaid