Healthcare Provider Details

I. General information

NPI: 1528990678
Provider Name (Legal Business Name): EUGENE KIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 FORT ST STE 106
OMAHA NE
68164-2183
US

IV. Provider business mailing address

1710 N 175TH PLZ
OMAHA NE
68118-6025
US

V. Phone/Fax

Practice location:
  • Phone: 402-492-8300
  • Fax:
Mailing address:
  • Phone: 402-213-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8195
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: