Provider Demographics
NPI:1174829857
Name:KIM, SEUNG HYUN (DDS)
Entity Type:Individual
Prefix:
First Name:SEUNG
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 8TH ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3038
Mailing Address - Country:US
Mailing Address - Phone:719-562-4447
Mailing Address - Fax:719-583-1801
Practice Address - Street 1:2100 MORSE CENTER ROAD
Practice Address - Street 2:STE 4655
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-470-9840
Practice Address - Fax:614-470-9841
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0233731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice