Healthcare Provider Details

I. General information

NPI: 1770294993
Provider Name (Legal Business Name): HALCYON DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOSEPH KIM
Title or Position: MANAGING MEMBER
Credential: DDS, JD
Phone: 331-444-1185