Provider Demographics
NPI:1003293077
Name:KIM, CHRIS S (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6797 PRELUDE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2978
Mailing Address - Country:US
Mailing Address - Phone:858-740-0706
Mailing Address - Fax:
Practice Address - Street 1:616 GAYLE ST STE 100
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3056
Practice Address - Country:US
Practice Address - Phone:659-200-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA71151223G0001X
SC110161223S0112X
GADN0151061223S0112X
TX382471223S0112X
ALD.007382-C1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice