Provider Demographics
NPI:1790340875
Name:KIM & WANG DDS PLLC
Entity Type:Organization
Organization Name:KIM & WANG DDS PLLC
Other - Org Name:K & W DENTAL AT FOREST HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:HAO
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-705-4908
Mailing Address - Street 1:107-37 71ST AVE
Mailing Address - Street 2:SUITE 203, MAILBOX #4
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-261-1432
Mailing Address - Fax:
Practice Address - Street 1:10737 71ST AVE STE 203
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4736
Practice Address - Country:US
Practice Address - Phone:718-261-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5530818OtherNY DEPARTMENT OF STATE