Healthcare Provider Details

I. General information

NPI: 1770429508
Provider Name (Legal Business Name): WILLIAM KIM DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3297 EAGLE RUN DR NE
GRAND RAPIDS MI
49525-7050
US

IV. Provider business mailing address

3297 EAGLE RUN DR NE
GRAND RAPIDS MI
49525-7050
US

V. Phone/Fax

Practice location:
  • Phone: 616-377-4759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: WANKI KIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 616-377-4759