Provider Demographics
NPI:1821306499
Name:KIM, MYUNGEUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYUNGEUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RIVER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8349
Mailing Address - Country:US
Mailing Address - Phone:781-891-7737
Mailing Address - Fax:
Practice Address - Street 1:85 RIVER ST STE 2
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8349
Practice Address - Country:US
Practice Address - Phone:781-891-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1855551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist