Provider Demographics
NPI:1609988153
Name:JOHN G CLINTHORNE DDS MS & HEAWON LUDIA KIM DMD MS PC
Entity Type:Organization
Organization Name:JOHN G CLINTHORNE DDS MS & HEAWON LUDIA KIM DMD MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:HEAWON
Authorized Official - Middle Name:LUDIA
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:734-761-3116
Mailing Address - Street 1:1303 PACKARD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3814
Mailing Address - Country:US
Mailing Address - Phone:734-761-3116
Mailing Address - Fax:734-761-5263
Practice Address - Street 1:1303 PACKARD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3814
Practice Address - Country:US
Practice Address - Phone:734-761-3116
Practice Address - Fax:734-761-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010168851223X0400X
MI29010124681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty