Provider Demographics
NPI:1942615364
Name:KIM-ALBADAWI, STEPHANIE (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:KIM-ALBADAWI
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MSD
Mailing Address - Street 1:252 MERCEDES CT
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0280
Mailing Address - Country:US
Mailing Address - Phone:661-203-1353
Mailing Address - Fax:
Practice Address - Street 1:13760 LAKERIDGE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7608
Practice Address - Country:US
Practice Address - Phone:317-588-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN12014639A1223P0221X
CA647621223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice