Provider Demographics
NPI:1124750757
Name:KIM, DANIEL DONG EUN (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DONG EUN
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 1:302 SATELLITE BLVD NE STE 216
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7185
Mailing Address - Country:US
Mailing Address - Phone:678-541-6020
Mailing Address - Fax:
Practice Address - Street 1:302 SATELLITE BLVD NE STE 216
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7185
Practice Address - Country:US
Practice Address - Phone:678-541-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice