Provider Demographics
NPI:1790282622
Name:KIM, PAUL DADO (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DADO
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 1:800 SEMMES AVE APT 910
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2367
Mailing Address - Country:US
Mailing Address - Phone:571-318-7768
Mailing Address - Fax:
Practice Address - Street 1:9325 CHAMBERLAYNE RD STE B240
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2895
Practice Address - Country:US
Practice Address - Phone:804-261-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401416459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program