Provider Demographics
NPI:1366591786
Name:KIM, NAMCHUL ROLAND (DDS)
Entity type:Individual
Prefix:DR
First Name:NAMCHUL
Middle Name:ROLAND
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 1:505 E GOLF RD
Mailing Address - Street 2:SUITE # C
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4088
Mailing Address - Country:US
Mailing Address - Phone:847-593-9000
Mailing Address - Fax:
Practice Address - Street 1:505 E GOLF RD
Practice Address - Street 2:SUITE # C
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4088
Practice Address - Country:US
Practice Address - Phone:847-593-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist