Provider Demographics
NPI:1962711374
Name:KIM, MYOUNG-WOOK (DDS)
Entity type:Individual
Prefix:DR
First Name:MYOUNG-WOOK
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 1:4670 PRESTANCIA PL
Mailing Address - Street 2:#304
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-4123
Mailing Address - Country:US
Mailing Address - Phone:917-929-4475
Mailing Address - Fax:
Practice Address - Street 1:5630 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6641
Practice Address - Country:US
Practice Address - Phone:540-548-4025
Practice Address - Fax:888-711-1858
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-03
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice