Healthcare Provider Details

I. General information

NPI: 1952618555
Provider Name (Legal Business Name): SEHWOON KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BUFORD DR STE K
BUFORD GA
30518-3459
US

IV. Provider business mailing address

807 N BELT LINE RD
IRVING TX
75061-6317
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-1000
  • Fax:
Mailing address:
  • Phone: 972-891-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28702
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123804
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: