Provider Demographics
NPI:1477629806
Name:KIM, JIN DEOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:DEOK
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-2413
Mailing Address - Country:US
Mailing Address - Phone:717-665-2440
Mailing Address - Fax:717-665-0104
Practice Address - Street 1:51 MARKET SQ
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-2413
Practice Address - Country:US
Practice Address - Phone:717-665-2440
Practice Address - Fax:717-665-0104
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031376L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist