Provider Demographics
NPI:1427630334
Name:KIM, DAMIAN (DDS)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
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 1:230 NEW SHACKLE ISLAND RD STE 170
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2485
Mailing Address - Country:US
Mailing Address - Phone:909-725-8976
Mailing Address - Fax:
Practice Address - Street 1:230 NEW SHACKLE ISLAND RD STE 170
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2485
Practice Address - Country:US
Practice Address - Phone:615-822-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11659122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist