Provider Demographics
NPI:1912278995
Name:KIM, JOONG HO (DDS)
Entity type:Individual
Prefix:DR
First Name:JOONG
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7665 NEW SECOND ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3410
Mailing Address - Country:US
Mailing Address - Phone:215-635-1235
Mailing Address - Fax:215-646-2627
Practice Address - Street 1:7665 NEW SECOND ST
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3410
Practice Address - Country:US
Practice Address - Phone:215-635-1235
Practice Address - Fax:215-646-2627
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS20400L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist