Provider Demographics
NPI:1851389225
Name:KIM, EUGENE JUNG (DDS)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:JUNG
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 1:8575 E PRINCESS DR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5483
Mailing Address - Country:US
Mailing Address - Phone:480-342-8200
Mailing Address - Fax:480-342-8008
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:SUITE 217
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-342-8200
Practice Address - Fax:480-342-8008
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ92511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49585711Medicaid
FK4401890OtherDEA
FK4854041OtherDEA