Provider Demographics
NPI:1316015134
Name:KIM, THOMAS SUNGWOOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SUNGWOOK
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:S
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:102 WINDING ROSE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2854
Mailing Address - Country:US
Mailing Address - Phone:301-990-7706
Mailing Address - Fax:
Practice Address - Street 1:19522 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5200
Practice Address - Country:US
Practice Address - Phone:301-540-9366
Practice Address - Fax:301-540-5571
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry