Provider Demographics
NPI:1962887216
Name:KIM, DARA (DDS)
Entity type:Individual
Prefix:DR
First Name:DARA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E 14TH ST
Mailing Address - Street 2:APT 6C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2909
Mailing Address - Country:US
Mailing Address - Phone:513-515-1555
Mailing Address - Fax:
Practice Address - Street 1:515 E 14TH ST
Practice Address - Street 2:APT 6C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2909
Practice Address - Country:US
Practice Address - Phone:513-515-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist