Provider Demographics
NPI:1679954432
Name:KIM, KYUNG HOON (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG HOON
Middle Name:
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 1:5 JACOB WAY
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2527
Mailing Address - Country:US
Mailing Address - Phone:215-350-8242
Mailing Address - Fax:
Practice Address - Street 1:545 W MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-1981
Practice Address - Country:US
Practice Address - Phone:484-200-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014181481223S0112X
MD177311223S0112X
PADS0421421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery