Provider Demographics
NPI:1245418268
Name:KIM, SARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
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 1:119 W 57TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2303
Mailing Address - Country:US
Mailing Address - Phone:212-582-8161
Mailing Address - Fax:212-315-5160
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-582-8161
Practice Address - Fax:212-315-5160
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0527791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics