Provider Demographics
NPI:1932277373
Name:KIM, HYUNG JOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:HYUNG
Middle Name:JOON
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 1:1421 S CATON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1025
Mailing Address - Country:US
Mailing Address - Phone:410-525-0100
Mailing Address - Fax:410-525-3524
Practice Address - Street 1:1421 S CATON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1025
Practice Address - Country:US
Practice Address - Phone:410-525-0100
Practice Address - Fax:410-525-3524
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice