Provider Demographics
NPI:1326320508
Name:KIM, SEOK (DDS)
Entity Type:Individual
Prefix:
First Name:SEOK
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 1:114 W 71ST ST
Mailing Address - Street 2:COSMETIC DENTISTRY OF NEW YORK
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4041
Mailing Address - Country:US
Mailing Address - Phone:212-721-4549
Mailing Address - Fax:212-501-7452
Practice Address - Street 1:114 W 71ST ST
Practice Address - Street 2:COSMETIC DENTISTRY OF NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4041
Practice Address - Country:US
Practice Address - Phone:212-721-4549
Practice Address - Fax:212-501-7452
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist