Provider Demographics
NPI:1205037835
Name:KIM, JOSEPH S (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
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 1:769 N HEARTLAND DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9346
Mailing Address - Country:US
Mailing Address - Phone:630-466-7445
Mailing Address - Fax:630-466-7405
Practice Address - Street 1:769 N HEARTLAND DR
Practice Address - Street 2:UNIT C
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-9346
Practice Address - Country:US
Practice Address - Phone:630-466-7445
Practice Address - Fax:630-466-7405
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0256701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL45-0486629OtherTAX ID NUMBER