Provider Demographics
NPI:1285033704
Name:KIM, STEPHAN SEOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:SEOK
Last Name:KIM
Suffix:
Gender:M
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:PSC 444 BOX 824
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96297-0009
Mailing Address - Country:US
Mailing Address - Phone:315-737-9187
Mailing Address - Fax:
Practice Address - Street 1:BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH)
Practice Address - Street 2:UNIT #15245
Practice Address - City:APO
Practice Address - State:CA
Practice Address - Zip Code:96271
Practice Address - Country:US
Practice Address - Phone:315-737-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02584000122300000X
PADS040117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist