Provider Demographics
NPI:1548227051
Name:KIM, CHUNG K (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:20 MAIN ST STE 17
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-2345
Mailing Address - Country:US
Mailing Address - Phone:860-623-2601
Mailing Address - Fax:860-370-5467
Practice Address - Street 1:20 MAIN ST STE 17
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-2345
Practice Address - Country:US
Practice Address - Phone:860-623-2601
Practice Address - Fax:860-370-5467
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice