Provider Demographics
NPI:1295042398
Name:KIM, JOONGHYUK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOONGHYUK
Middle Name:
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 1:5450 KNOLL NORTH DR STE 310
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2369
Mailing Address - Country:US
Mailing Address - Phone:443-545-5058
Mailing Address - Fax:
Practice Address - Street 1:5450 KNOLL NORTH DR STE 310
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2369
Practice Address - Country:US
Practice Address - Phone:443-545-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry