Provider Demographics
NPI:1255584546
Name:KYEONGSEON KIM, DDS, PLLC
Entity type:Organization
Organization Name:KYEONGSEON KIM, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KYEONGSEON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-547-0066
Mailing Address - Street 1:1717 W UNIVERSITY DR
Mailing Address - Street 2:STE 410
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3220
Mailing Address - Country:US
Mailing Address - Phone:972-547-0066
Mailing Address - Fax:972-547-0069
Practice Address - Street 1:1717 W UNIVERSITY DR.
Practice Address - Street 2:STE 410
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3220
Practice Address - Country:US
Practice Address - Phone:972-547-0066
Practice Address - Fax:972-547-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty