Provider Demographics
NPI:1255061909
Name:KWANG W KIM, DDS, PLLC
Entity type:Organization
Organization Name:KWANG W KIM, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-572-4928
Mailing Address - Street 1:410 MINERAL ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-3716
Mailing Address - Country:US
Mailing Address - Phone:434-572-4928
Mailing Address - Fax:434-575-0302
Practice Address - Street 1:410 MINERAL ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3716
Practice Address - Country:US
Practice Address - Phone:434-572-4928
Practice Address - Fax:434-575-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty