Healthcare Provider Details

I. General information

NPI: 1497901250
Provider Name (Legal Business Name): CAL KYUNG-HONG KIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILLOWBROOK DENTISTRY FOR CHILDREN 7000 S ADAMS ST SUITE 111
WILLOWBROOK IL
60527
US

IV. Provider business mailing address

736 SKYLINE DR
BARRINGTON IL
60010-4239
US

V. Phone/Fax

Practice location:
  • Phone: 630-570-0858
  • Fax: 630-570-0870
Mailing address:
  • Phone: 401-626-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number019.029455
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN03014
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: