Provider Demographics
NPI:1316197817
Name:KIM, SHARON MIA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MIA
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8981 W SAHARA AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5897
Mailing Address - Country:US
Mailing Address - Phone:702-220-7878
Mailing Address - Fax:
Practice Address - Street 1:8981 W SAHARA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5897
Practice Address - Country:US
Practice Address - Phone:702-220-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-1761223X0400X
CA577261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics