Provider Demographics
NPI:1255533105
Name:KIM, HEAWON LUDIA (DMD)
Entity type:Individual
Prefix:DR
First Name:HEAWON
Middle Name:LUDIA
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1303 PACKARD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3874
Mailing Address - Country:US
Mailing Address - Phone:734-761-3116
Mailing Address - Fax:734-761-5263
Practice Address - Street 1:1303 PACKARD ST STE 101
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3874
Practice Address - Country:US
Practice Address - Phone:734-761-3116
Practice Address - Fax:734-761-5263
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010168851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics