Healthcare Provider Details

I. General information

NPI: 1598968315
Provider Name (Legal Business Name): CHRISTOPHER CHAEHO KIM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 EVERGREEN PKWY
EVERGREEN CO
80439-7922
US

IV. Provider business mailing address

211 MILL VALLEY DR
COLLEYVILLE TX
76034-3667
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-5566
  • Fax: 303-674-8911
Mailing address:
  • Phone: 972-948-9574
  • Fax: 817-514-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00206430
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: