Provider Demographics
NPI:1932321759
Name:KIM, DONGKYUN DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONGKYUN
Middle Name:DANIEL
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 1:321 BROAD AVE BUILDING F UNIT # 5
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657
Mailing Address - Country:US
Mailing Address - Phone:201-313-2277
Mailing Address - Fax:201-313-0377
Practice Address - Street 1:321 BROAD AVE BUILDING F UNIT # 5
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657
Practice Address - Country:US
Practice Address - Phone:201-313-2277
Practice Address - Fax:201-313-0377
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice