Provider Demographics
NPI:1487956520
Name:KIM, ANGELA S (DMD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2524
Mailing Address - Country:US
Mailing Address - Phone:917-674-8778
Mailing Address - Fax:201-470-5789
Practice Address - Street 1:700 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3058
Practice Address - Country:US
Practice Address - Phone:917-674-8778
Practice Address - Fax:201-470-5789
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02460200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist