Provider Demographics
NPI:1598968315
Name:KIM, CHRISTOPHER CHAEHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CHAEHO
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MILL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3667
Mailing Address - Country:US
Mailing Address - Phone:972-948-9574
Mailing Address - Fax:817-514-2349
Practice Address - Street 1:5040 N. TARRANT PKWY
Practice Address - Street 2:SUITE #118
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:972-948-9574
Practice Address - Fax:817-514-2349
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice