Provider Demographics
NPI:1871673871
Name:KIM, JOSEPH M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
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 1:10 STOWER LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2610
Mailing Address - Country:US
Mailing Address - Phone:419-663-4466
Mailing Address - Fax:419-663-4499
Practice Address - Street 1:10 STOWER LN
Practice Address - Street 2:SUITE C
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2610
Practice Address - Country:US
Practice Address - Phone:419-663-4466
Practice Address - Fax:419-663-4499
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH205721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice