Provider Demographics
NPI:1760586192
Name:KIM, DONGWOOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONGWOOK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:341 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1701
Mailing Address - Country:US
Mailing Address - Phone:201-363-9890
Mailing Address - Fax:201-363-9897
Practice Address - Street 1:384 BROAD AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1701
Practice Address - Country:US
Practice Address - Phone:201-363-9890
Practice Address - Fax:201-363-9897
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI202631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice