Provider Demographics
NPI:1720462096
Name:KIM, CRYSTAL (DMD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14749 W 87TH PKWY UNIT C
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-1337
Mailing Address - Country:US
Mailing Address - Phone:720-779-0088
Mailing Address - Fax:720-779-0099
Practice Address - Street 1:14749 W 87TH PKWY UNIT C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-1337
Practice Address - Country:US
Practice Address - Phone:720-779-0088
Practice Address - Fax:720-779-0099
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO203890122300000X
FL21397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist