Provider Demographics
NPI:1972171940
Name:KWANG HAN KIM DDS, PL
Entity type:Organization
Organization Name:KWANG HAN KIM DDS, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:HAN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-344-3610
Mailing Address - Street 1:2071 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4101
Mailing Address - Country:US
Mailing Address - Phone:212-970-1122
Mailing Address - Fax:212-970-1105
Practice Address - Street 1:2071 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4101
Practice Address - Country:US
Practice Address - Phone:212-970-1122
Practice Address - Fax:212-970-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03289865Medicaid