Provider Demographics
NPI:1316434947
Name:KIM, SOO-KEUN SEAN (DMD, MD)
Entity type:Individual
Prefix:
First Name:SOO-KEUN
Middle Name:SEAN
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 WESTCHESTER AVE STE G02
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2500
Mailing Address - Country:US
Mailing Address - Phone:914-251-0313
Mailing Address - Fax:
Practice Address - Street 1:2975 WESTCHESTER AVE STE G02
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2500
Practice Address - Country:US
Practice Address - Phone:914-251-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist