Healthcare Provider Details

I. General information

NPI: 1801711486
Provider Name (Legal Business Name): INA URI KIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 MISSISSIPPI AVENUE BUILDING 1651
FORT POLK LA
71459
US

IV. Provider business mailing address

7223 MISSISSIPPI AVENUE BUILDING 1651
FORT POLK LA
71459
US

V. Phone/Fax

Practice location:
  • Phone: 726-780-1290
  • Fax:
Mailing address:
  • Phone: 726-780-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42386
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: