Provider Demographics
NPI:1265879019
Name:DR. SEAN KIM DDS MD PLLC
Entity type:Organization
Organization Name:DR. SEAN KIM DDS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:832-831-8655
Mailing Address - Street 1:1800 W 26TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1450
Mailing Address - Country:US
Mailing Address - Phone:832-831-8655
Mailing Address - Fax:832-581-2253
Practice Address - Street 1:1800 W 26TH ST STE 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1450
Practice Address - Country:US
Practice Address - Phone:832-831-8655
Practice Address - Fax:832-581-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty