Provider Demographics
NPI:1942407812
Name:KIM, CLAY HAKMIN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:HAKMIN
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
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Mailing Address - Street 1:3150 W WARD RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3056
Mailing Address - Country:US
Mailing Address - Phone:410-257-5333
Mailing Address - Fax:410-257-4364
Practice Address - Street 1:3150 W WARD RD STE 306
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3057
Practice Address - Country:US
Practice Address - Phone:410-257-5333
Practice Address - Fax:410-257-4364
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0377121223G0001X
MD157361223S0112X
PADS-0377121223S0112X
MDD0078954204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery