Healthcare Provider Details

I. General information

NPI: 1205037835
Provider Name (Legal Business Name): JOSEPH S. KIM DDS, JD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 W GALENA BLVD STE 11
AURORA IL
60506-4483
US

IV. Provider business mailing address

1940 W GALENA BLVD STE 12
AURORA IL
60506-4483
US

V. Phone/Fax

Practice location:
  • Phone: 331-444-1185
  • Fax: 630-466-7405
Mailing address:
  • Phone: 331-444-1185
  • Fax: 630-466-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.025670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: