Provider Demographics
NPI:1134343924
Name:JAMES S KIM DDS SC
Entity type:Organization
Organization Name:JAMES S KIM DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-849-5667
Mailing Address - Street 1:501 S 24TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5225
Mailing Address - Country:US
Mailing Address - Phone:715-849-5667
Mailing Address - Fax:715-849-5667
Practice Address - Street 1:501 S 24TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5225
Practice Address - Country:US
Practice Address - Phone:715-849-5667
Practice Address - Fax:715-849-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48781223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty