Provider Demographics
NPI:1255455143
Name:KIM, HEEJUNG (DDS)
Entity type:Individual
Prefix:
First Name:HEEJUNG
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 1:9501 OLD ANNAPOLIS RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6336
Mailing Address - Country:US
Mailing Address - Phone:443-878-0770
Mailing Address - Fax:410-740-1486
Practice Address - Street 1:9501 OLD ANNAPOLIS RD STE 200A
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6336
Practice Address - Country:US
Practice Address - Phone:410-740-1484
Practice Address - Fax:410-740-1486
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137331223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice