Provider Demographics
NPI:1164404646
Name:KIM, HAN CHU (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:HAN CHU
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 POST OAK PLACE DR
Mailing Address - Street 2:STE 108
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3160
Mailing Address - Country:US
Mailing Address - Phone:713-629-5170
Mailing Address - Fax:713-629-5172
Practice Address - Street 1:4543 POST OAK PLACE
Practice Address - Street 2:STE 108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3160
Practice Address - Country:US
Practice Address - Phone:713-629-5170
Practice Address - Fax:713-629-5172
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics