Provider Demographics
NPI:1568919686
Name:KIM, PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
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:HQ, 618TH DENTAL COMPANY (AS)
Mailing Address - Street 2:USA, HEALTH DENTAL ACTIVITY-KOREA
Mailing Address - City:SEOUL
Mailing Address - State:APO AP
Mailing Address - Zip Code:96205-5652
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HQ, 618TH DENTAL COMPANY (AS)
Practice Address - Street 2:USA, HEALTH DENTAL ACTIVITY-KOREA
Practice Address - City:SEOUL
Practice Address - State:APO AP
Practice Address - Zip Code:96205-5652
Practice Address - Country:KR
Practice Address - Phone:011-822-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9839475-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist