Provider Demographics
NPI:1194478305
Name:KIM, THOMAS SUNGYEOB (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SUNGYEOB
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N HOUSTON ST APT 404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7898
Mailing Address - Country:US
Mailing Address - Phone:248-794-4878
Mailing Address - Fax:
Practice Address - Street 1:4770 LOHR RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9534
Practice Address - Country:US
Practice Address - Phone:248-794-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program