Provider Demographics
NPI:1588143754
Name:KIM, KATHY CHONG EUN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:CHONG EUN
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:360 S MONROE ST APT 523
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3735
Mailing Address - Country:US
Mailing Address - Phone:720-236-4520
Mailing Address - Fax:
Practice Address - Street 1:4760 W MINERAL AVE STE 60
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-2540
Practice Address - Country:US
Practice Address - Phone:303-327-9553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002036551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice