Provider Demographics
NPI:1780899328
Name:KIM, ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 32ND ST
Mailing Address - Street 2:5TH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3817
Mailing Address - Country:US
Mailing Address - Phone:212-868-3131
Mailing Address - Fax:212-868-3553
Practice Address - Street 1:30 W 32ND ST
Practice Address - Street 2:5TH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3817
Practice Address - Country:US
Practice Address - Phone:212-868-3131
Practice Address - Fax:212-868-3553
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0486801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice