Provider Demographics
NPI:1255872016
Name:DR. SUN HYUN KIM DMD P.C
Entity type:Organization
Organization Name:DR. SUN HYUN KIM DMD P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:540-699-2414
Mailing Address - Street 1:556 GARRISONVILLE RD
Mailing Address - Street 2:STE 208
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:556 GARRISONVILLE RD
Practice Address - Street 2:STE 208
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7826
Practice Address - Country:US
Practice Address - Phone:540-699-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01414124961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty