Provider Demographics
NPI:1912944562
Name:KIL, NAM EUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAM EUN
Middle Name:
Last Name:KIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1905 SCENIC HWY N STE 510
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5635
Mailing Address - Country:US
Mailing Address - Phone:770-979-6400
Mailing Address - Fax:770-979-7465
Practice Address - Street 1:3820 PLEASANT HILL RD
Practice Address - Street 2:STE 1
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1429
Practice Address - Country:US
Practice Address - Phone:770-497-0110
Practice Address - Fax:770-497-0580
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000949616CMedicaid
GA000949616BMedicaid