Provider Demographics
NPI:1023219045
Name:KIM, SUNG H (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:H
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 1:14936 NORTHERN BLVD
Mailing Address - Street 2:#201
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3884
Mailing Address - Country:US
Mailing Address - Phone:718-888-9446
Mailing Address - Fax:
Practice Address - Street 1:14936 NORTHERN BLVD
Practice Address - Street 2:#201
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3884
Practice Address - Country:US
Practice Address - Phone:718-888-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01885700122300000X
NY0451751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBK4153867OtherDEA