Provider Demographics
NPI:1124483250
Name:CALEB & TYLER KIM DDS LLC
Entity type:Organization
Organization Name:CALEB & TYLER KIM DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNHYCK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-652-7711
Mailing Address - Street 1:119 1ST ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1575
Mailing Address - Country:US
Mailing Address - Phone:201-652-7711
Mailing Address - Fax:201-652-7350
Practice Address - Street 1:119 1ST ST
Practice Address - Street 2:SUITE #2
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1575
Practice Address - Country:US
Practice Address - Phone:201-652-7711
Practice Address - Fax:201-652-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024891001223P0300X
NJ22DI025964001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty