Healthcare Provider Details

I. General information

NPI: 1053545699
Provider Name (Legal Business Name): HENRY KIM DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 US HIGHWAY 1 SUITE 220
NORTH PALM BEACH FL
33408-4525
US

IV. Provider business mailing address

712 US HIGHWAY 1 SUITE 220
NORTH PALM BEACH FL
33408-4525
US

V. Phone/Fax

Practice location:
  • Phone: 561-881-0067
  • Fax: 561-881-5707
Mailing address:
  • Phone: 561-881-0067
  • Fax: 561-881-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN18525
License Number StateFL

VIII. Authorized Official

Name: DR. HYUNYIL HENRY KIM
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 561-252-3981