Provider Demographics
NPI:1417171281
Name:DO, PHUONG KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:KIM
Last Name:DO
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:3010 LYNDON B JOHNSON FWY
Mailing Address - Street 2:STE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7770
Mailing Address - Country:US
Mailing Address - Phone:972-444-8888
Mailing Address - Fax:972-488-1899
Practice Address - Street 1:3010 LYNDON B JOHNSON FWY
Practice Address - Street 2:STE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7770
Practice Address - Country:US
Practice Address - Phone:972-444-8888
Practice Address - Fax:972-488-1899
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX220791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery