Provider Demographics
NPI:1205446226
Name:KIM, DOO HYUN (DDS)
Entity type:Individual
Prefix:
First Name:DOO HYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W HUBBARD ST APT 2505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4619
Mailing Address - Country:US
Mailing Address - Phone:718-925-1522
Mailing Address - Fax:
Practice Address - Street 1:6560 W FULLERTON AVE UNIT C106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3439
Practice Address - Country:US
Practice Address - Phone:773-385-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190328621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice