Provider Demographics
NPI:1821215039
Name:KIM, MYUNG JOON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYUNG
Middle Name:JOON
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 1:10 MARKET SQUARE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281
Mailing Address - Country:US
Mailing Address - Phone:207-743-8701
Mailing Address - Fax:207-743-2787
Practice Address - Street 1:10 MARKET SQUARE
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH PARIS
Practice Address - State:ME
Practice Address - Zip Code:04281
Practice Address - Country:US
Practice Address - Phone:207-743-8701
Practice Address - Fax:207-743-2787
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist