Provider Demographics
NPI:1225230998
Name:KIM, SEAN HYUNGBEOM
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:HYUNGBEOM
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SEAN
Other - Middle Name:HYUNGBEOM
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:115 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3603
Mailing Address - Country:US
Mailing Address - Phone:860-446-8744
Mailing Address - Fax:860-448-3780
Practice Address - Street 1:115 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3603
Practice Address - Country:US
Practice Address - Phone:860-446-8744
Practice Address - Fax:860-448-3780
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT87161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice