Provider Demographics
NPI:1386094696
Name:KIM, GAIL (DMD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MCLAUGHLIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-3100
Mailing Address - Country:US
Mailing Address - Phone:412-992-8306
Mailing Address - Fax:
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3100
Practice Address - Country:US
Practice Address - Phone:412-257-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000269122300000X
VA04014159501223P0221X
PADS0420721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist