Provider Demographics
NPI:1164908208
Name:KIM, SEULAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEULAH
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 1:9212 FALLS OF NEUSE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2483
Mailing Address - Country:US
Mailing Address - Phone:919-845-7778
Mailing Address - Fax:
Practice Address - Street 1:9212 FALLS OF NEUSE RD STE 215
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2483
Practice Address - Country:US
Practice Address - Phone:919-845-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice