Provider Demographics
NPI:1316227499
Name:KIM, SHAWN SEONGHOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:SEONGHOON
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 1:1138 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136
Mailing Address - Country:US
Mailing Address - Phone:213-700-9838
Mailing Address - Fax:
Practice Address - Street 1:1138 RIVER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2970
Practice Address - Country:US
Practice Address - Phone:213-700-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18561471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice