Provider Demographics
NPI:1477818284
Name:KIM, SUNG H (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:H
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 1:4875 GRAMERCY OAKS DR
Mailing Address - Street 2:APT#210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5335
Mailing Address - Country:US
Mailing Address - Phone:903-293-4588
Mailing Address - Fax:
Practice Address - Street 1:700 ALMA DR
Practice Address - Street 2:SUITE #109
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8844
Practice Address - Country:US
Practice Address - Phone:972-423-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice