Provider Demographics
NPI:1750522181
Name:KIM, SUNG JOO (DMD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:JOO
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 WATERLOO WALK
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6914
Mailing Address - Country:US
Mailing Address - Phone:240-264-7143
Mailing Address - Fax:
Practice Address - Street 1:7302 WATERLOO WALK
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6914
Practice Address - Country:US
Practice Address - Phone:240-264-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-15
Last Update Date:2009-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD142741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice