Provider Demographics
NPI:1437212826
Name:KIM, JOONGSEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOONGSEO
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 1:301 MAPLE AVE. WEST # 610
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-281-7011
Mailing Address - Fax:703-281-7030
Practice Address - Street 1:301 MAPLE AVE. WEST # 610
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-281-7011
Practice Address - Fax:703-281-7030
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12296122300000X
VA04010088471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist