Provider Demographics
NPI:1316174923
Name:KIM, SUN HYUN (DMD)
Entity type:Individual
Prefix:DR
First Name:SUN
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 GARRISONVILLE RD
Mailing Address - Street 2:STE 208
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:556 GARRISONVILLE RD
Practice Address - Street 2:STE 208
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7826
Practice Address - Country:US
Practice Address - Phone:540-699-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014124961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice