Provider Demographics
NPI:1720064132
Name:KIM, PHIL JOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:JOE
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4865 HEDGCOXE RD.
Mailing Address - Street 2:STE. 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-505-2210
Mailing Address - Fax:972-505-2212
Practice Address - Street 1:4865 HEDGCOXE RD.
Practice Address - Street 2:STE. 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-505-2210
Practice Address - Fax:972-505-2212
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery