Provider Demographics
NPI:1215940432
Name:KIM, RAYMOND N (DDS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:N
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 1:7312 W CHEYENNE AVE
Mailing Address - Street 2:SUIE 3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7428
Mailing Address - Country:US
Mailing Address - Phone:702-396-9924
Mailing Address - Fax:702-396-3735
Practice Address - Street 1:7312 W CHEYENNE AVE
Practice Address - Street 2:SUIE 3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7428
Practice Address - Country:US
Practice Address - Phone:702-396-9924
Practice Address - Fax:702-396-3735
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3336122300000X
CA43028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist