Provider Demographics
NPI:1366654360
Name:KIM, BYUNGTAE HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BYUNGTAE
Middle Name:HENRY
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 1:570 PIERMONT RD.
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624
Mailing Address - Country:US
Mailing Address - Phone:201-750-7190
Mailing Address - Fax:201-750-7192
Practice Address - Street 1:570 PIERMONT RD.
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624
Practice Address - Country:US
Practice Address - Phone:201-750-7190
Practice Address - Fax:201-750-7192
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ131511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics