Provider Demographics
NPI:1124485644
Name:KYM, SARAH
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:KYM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JIWON
Other - Middle Name:SARAH
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2656 W BROADWAY BLVD UNIT 10203
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1360 W IRVINGTON RD STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-4102
Practice Address - Country:US
Practice Address - Phone:520-206-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice