Provider Demographics
NPI:1457560229
Name:KIM, SOO B (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOO
Middle Name:B
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 FOREST AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5426
Mailing Address - Country:US
Mailing Address - Phone:201-599-1888
Mailing Address - Fax:201-599-1334
Practice Address - Street 1:275 FOREST AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5426
Practice Address - Country:US
Practice Address - Phone:201-599-1888
Practice Address - Fax:201-599-1334
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice