Provider Demographics
NPI:1356406458
Name:KIM, BENEDICT HEEKYU (DDS)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:HEEKYU
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:36309 MONTROSE WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3495
Mailing Address - Country:US
Mailing Address - Phone:440-934-0715
Mailing Address - Fax:440-934-0716
Practice Address - Street 1:3865 ROCKY RIVER DR
Practice Address - Street 2:SUITE #6
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4114
Practice Address - Country:US
Practice Address - Phone:216-251-8826
Practice Address - Fax:216-251-8464
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH198881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0003072OtherASSURANT
MIJ671066OtherBLUE CROSS BLUE SHIELD
FL213158OtherCIGNA HMO
IL994487OtherCOMPNET PPO