Provider Demographics
NPI:1558131185
Name:KIM, CHONGHWA
Entity Type:Individual
Prefix:DR
First Name:CHONGHWA
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIV. OF IOWA DENTAL SCHOOL, 801 NEWTON RD
Mailing Address - Street 2:342 DSB S
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-335-7321
Mailing Address - Fax:
Practice Address - Street 1:UNIV. OF IOWA DENTAL SCHOOL, 801 NEWTON RD
Practice Address - Street 2:342 DSB S
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-335-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAFAC-40230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist