Provider Demographics
NPI:1427227545
Name:TOMMY L KIM, DDS, PA
Entity Type:Organization
Organization Name:TOMMY L KIM, DDS, PA
Other - Org Name:PROSPERITY PARK CENTER FOR DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-948-5684
Mailing Address - Street 1:10220 PROSPERITY PARK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1105
Mailing Address - Country:US
Mailing Address - Phone:704-948-5684
Mailing Address - Fax:
Practice Address - Street 1:10220 PROSPERITY PARK RD
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1105
Practice Address - Country:US
Practice Address - Phone:704-948-5684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty