Healthcare Provider Details

I. General information

NPI: 1568919686
Provider Name (Legal Business Name): PAUL KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 LILLINGTON HWY
SPRING LAKE NC
28390-2269
US

IV. Provider business mailing address

HQ, 618TH DENTAL COMPANY (AS) USA, HEALTH DENTAL ACTIVITY-KOREA
SEOUL APO AP
96205-5652
KR

V. Phone/Fax

Practice location:
  • Phone: 910-212-6116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9839475-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: