Provider Demographics
NPI:1497147037
Name:KIM, DAVID TAESUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TAESUN
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 1:1430 JOHN WESLEY GILBERT DR
Mailing Address - Street 2:GC-1353
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-1000
Mailing Address - Country:US
Mailing Address - Phone:706-721-2881
Mailing Address - Fax:
Practice Address - Street 1:1430 JOHN WESLEY GILBERT DR
Practice Address - Street 2:GC-1353
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-1000
Practice Address - Country:US
Practice Address - Phone:706-721-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program