Provider Demographics
NPI:1649593971
Name:DR. KIM'S DENTAL, INC
Entity Type:Organization
Organization Name:DR. KIM'S DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOON KI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-399-1466
Mailing Address - Street 1:2216 ROYAL LN
Mailing Address - Street 2:115
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-7814
Mailing Address - Country:US
Mailing Address - Phone:972-243-0365
Mailing Address - Fax:972-247-0898
Practice Address - Street 1:2216 ROYAL LN
Practice Address - Street 2:115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-7814
Practice Address - Country:US
Practice Address - Phone:972-243-0365
Practice Address - Fax:972-247-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty