Provider Demographics
NPI:1952582462
Name:KIM, HYE-EUN (DMD)
Entity Type:Individual
Prefix:
First Name:HYE-EUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:W. COLLINGSWOOD HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08059
Mailing Address - Country:US
Mailing Address - Phone:856-742-1440
Mailing Address - Fax:856-742-1601
Practice Address - Street 1:800 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:W. COLLINGSWOOD HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08059
Practice Address - Country:US
Practice Address - Phone:856-742-1440
Practice Address - Fax:856-742-1601
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102344400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist