Provider Demographics
NPI:1477676013
Name:KIM, DOSUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOSUNG
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:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:CONDON
Mailing Address - State:MT
Mailing Address - Zip Code:59826-0918
Mailing Address - Country:US
Mailing Address - Phone:406-754-3200
Mailing Address - Fax:406-754-3202
Practice Address - Street 1:7245 MT HWY 83
Practice Address - Street 2:
Practice Address - City:CONDON
Practice Address - State:MT
Practice Address - Zip Code:59826-0918
Practice Address - Country:US
Practice Address - Phone:406-754-3200
Practice Address - Fax:406-754-3202
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice