Healthcare Provider Details

I. General information

NPI: 1366924144
Provider Name (Legal Business Name): HENRY ROK KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 S BLOOMINGDALE RD STE 102
BLOOMINGDALE IL
60108-1454
US

IV. Provider business mailing address

183 S BLOOMINGDALE RD STE 102
BLOOMINGDALE IL
60108-1454
US

V. Phone/Fax

Practice location:
  • Phone: 224-520-8665
  • Fax: 224-520-8647
Mailing address:
  • Phone: 469-232-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.032197
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number019.032197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: