Provider Demographics
NPI:1164743258
Name:KIM, MIN JUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIN JUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W 58TH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1827
Mailing Address - Country:US
Mailing Address - Phone:212-600-5221
Mailing Address - Fax:917-210-3909
Practice Address - Street 1:330 W 58TH ST
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:212-600-5221
Practice Address - Fax:917-210-3909
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05520511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice