Provider Demographics
NPI:1851469704
Name:KIM, EUNGHWAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUNGHWAN
Middle Name:
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 1:40TH AND HOLDREGE
Mailing Address - Street 2:UNMC COLLEGE OF DENTISTRY
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0740
Mailing Address - Country:US
Mailing Address - Phone:402-472-3052
Mailing Address - Fax:
Practice Address - Street 1:40TH AND HOLDREGE
Practice Address - Street 2:UNMC COLLEGE OF DENTISTRY
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0740
Practice Address - Country:US
Practice Address - Phone:402-472-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106961223P0700X
NE1031223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5194OtherBC/BS
NEU99177Medicare UPIN