Healthcare Provider Details

I. General information

NPI: 1386393940
Provider Name (Legal Business Name): AK ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 HUBBARD DR
NORTH BETHESDA MD
20852-4823
US

IV. Provider business mailing address

5904 HUBBARD DR
NORTH BETHESDA MD
20852-4823
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-8306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: ANA KIM
Title or Position: DMD
Credential:
Phone: 301-366-2237