Provider Demographics
NPI:1386828663
Name:KIM, WOOK S (DDS)
Entity Type:Individual
Prefix:DR
First Name:WOOK
Middle Name:S
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 1:15856 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4546
Mailing Address - Country:US
Mailing Address - Phone:708-460-6666
Mailing Address - Fax:708-460-6673
Practice Address - Street 1:15856 WOLF RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4546
Practice Address - Country:US
Practice Address - Phone:708-460-6666
Practice Address - Fax:708-460-6673
Is Sole Proprietor?:No
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice