Provider Demographics
NPI:1487437968
Name:KIM, JOSHUA JEONGWAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JEONGWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S BRYN MAWR AVE APT K40
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-4249
Mailing Address - Country:US
Mailing Address - Phone:609-933-3233
Mailing Address - Fax:
Practice Address - Street 1:3700 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3173
Practice Address - Country:US
Practice Address - Phone:215-387-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03019500122300000X
PADS0441601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist