Provider Demographics
NPI:1578759254
Name:KIM, AMY SUNG-OK (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUNG-OK
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6515
Mailing Address - Country:US
Mailing Address - Phone:734-332-8763
Mailing Address - Fax:
Practice Address - Street 1:619 RIDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6515
Practice Address - Country:US
Practice Address - Phone:734-332-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist