Provider Demographics
NPI:1477643823
Name:KIM, PAUL HOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HOON
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 1:461 NE GREENWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-678-5060
Mailing Address - Fax:541-306-4004
Practice Address - Street 1:461 NE GREENWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-678-5060
Practice Address - Fax:541-306-4004
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice