Provider Demographics
NPI:1578811717
Name:KIM, KYUNG JOON (DMD)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:JOON
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 1:7515 W YALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3423
Mailing Address - Country:US
Mailing Address - Phone:303-988-3319
Mailing Address - Fax:303-988-3492
Practice Address - Street 1:7515 W YALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-3423
Practice Address - Country:US
Practice Address - Phone:303-988-3319
Practice Address - Fax:303-988-3492
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2018351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice