Provider Demographics
NPI:1972772564
Name:KIM, JONG MIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:MIN
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 NICHOLSON LANE
Mailing Address - Street 2:SUITE#T-123
Mailing Address - City:N. BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-770-2270
Mailing Address - Fax:301-770-2246
Practice Address - Street 1:5809 NICHOLSON LANE
Practice Address - Street 2:SUITE#T-123
Practice Address - City:N. BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-770-2270
Practice Address - Fax:301-770-2246
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice