Provider Demographics
NPI:1891363289
Name:KIM, BRIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIANA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 CARMAN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8000
Mailing Address - Country:US
Mailing Address - Phone:314-795-5101
Mailing Address - Fax:
Practice Address - Street 1:17611 E US HWY 24, STE HCC
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056
Practice Address - Country:US
Practice Address - Phone:877-344-3572
Practice Address - Fax:866-228-4492
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist