Provider Demographics
NPI:1962872028
Name:KIM, RAYMOND JIHOON (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JIHOON
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 1:35300 WOODWARD AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0955
Mailing Address - Country:US
Mailing Address - Phone:231-740-3014
Mailing Address - Fax:
Practice Address - Street 1:35300 WOODWARD AVE APT 307
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-0955
Practice Address - Country:US
Practice Address - Phone:231-740-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist