Provider Demographics
NPI:1023286556
Name:KIM, KWANG SOO STEVE (DDS)
Entity type:Individual
Prefix:DR
First Name:KWANG SOO
Middle Name:STEVE
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 1:2640 PATRIOT BLVD
Mailing Address - Street 2:SUITE #270
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:847-901-6553
Mailing Address - Fax:847-901-6588
Practice Address - Street 1:2640 PATRIOT BLVD
Practice Address - Street 2:SUITE #270
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8075
Practice Address - Country:US
Practice Address - Phone:847-901-6553
Practice Address - Fax:847-901-6588
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL-019-0230981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice