Provider Demographics
NPI:1841473634
Name:KIM, SEUNG WOOK (DDS)
Entity type:Individual
Prefix:
First Name:SEUNG
Middle Name:WOOK
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 1:6800 BACKLICK RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3070
Mailing Address - Country:US
Mailing Address - Phone:703-569-2822
Mailing Address - Fax:703-569-2829
Practice Address - Street 1:6800 BACKLICK RD
Practice Address - Street 2:SUITE #101
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3070
Practice Address - Country:US
Practice Address - Phone:703-569-2822
Practice Address - Fax:703-569-2829
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice