Provider Demographics
NPI:1669941696
Name:KIM AND KIM DDS LLC
Entity type:Organization
Organization Name:KIM AND KIM DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN
Authorized Official - Middle Name:HYCK
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-218-0770
Mailing Address - Street 1:10 N GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2434
Mailing Address - Country:US
Mailing Address - Phone:908-218-0770
Mailing Address - Fax:908-218-9789
Practice Address - Street 1:10 N GASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2434
Practice Address - Country:US
Practice Address - Phone:908-218-0770
Practice Address - Fax:908-218-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DJ02489100OtherNEW JERSEY