Provider Demographics
NPI:1295048395
Name:KIM, HAWOON (DDS)
Entity type:Individual
Prefix:
First Name:HAWOON
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 1:1231 E PIONEER PKWY # 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5886
Mailing Address - Country:US
Mailing Address - Phone:178-462-1022
Mailing Address - Fax:817-462-0255
Practice Address - Street 1:1231 E PIONEER PKWY # 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5886
Practice Address - Country:US
Practice Address - Phone:817-462-1022
Practice Address - Fax:817-462-0255
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257881223G0001X
TX00257881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528482452Medicaid