Provider Demographics
NPI:1477745388
Name:KIM, JAE WOO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:WOO
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:JAEWOO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:403 N FIVE POINTS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4632
Mailing Address - Country:US
Mailing Address - Phone:610-696-3371
Mailing Address - Fax:610-696-5058
Practice Address - Street 1:403 N FIVE POINTS RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4632
Practice Address - Country:US
Practice Address - Phone:610-696-3371
Practice Address - Fax:610-696-5058
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0373091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice