Healthcare Provider Details

I. General information

NPI: 1588486831
Provider Name (Legal Business Name): SEUNGCHAN KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E SHERMAN BLVD
MUSKEGON MI
49444-1862
US

IV. Provider business mailing address

1725 E SHERMAN BLVD
MUSKEGON MI
49444-1862
US

V. Phone/Fax

Practice location:
  • Phone: 231-737-0037
  • Fax:
Mailing address:
  • Phone: 231-737-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602631
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: