Provider Demographics
NPI:1740855618
Name:KIM, SARAH EUNHA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:EUNHA
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 EDDY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4978
Mailing Address - Country:US
Mailing Address - Phone:206-499-9412
Mailing Address - Fax:
Practice Address - Street 1:3211 COORS BLVD SW STE D2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5255
Practice Address - Country:US
Practice Address - Phone:505-336-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS108665122300000X
NMDD5477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist