Provider Demographics
NPI:1306969597
Name:HENRY H. KIM, DDS,LTD
Entity type:Organization
Organization Name:HENRY H. KIM, DDS,LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-876-3222
Mailing Address - Street 1:5680 W FLAMINGO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-0169
Mailing Address - Country:US
Mailing Address - Phone:702-876-3222
Mailing Address - Fax:702-876-4422
Practice Address - Street 1:5680 W FLAMINGO RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-0169
Practice Address - Country:US
Practice Address - Phone:702-876-3222
Practice Address - Fax:702-876-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4895T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty