Healthcare Provider Details

I. General information

NPI: 1538949714
Provider Name (Legal Business Name): DONG-KYU KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. DONG-KYU KIM

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3896 N MARTIN LUTHER KING BLVD
NORTH LAS VEGAS NV
89032
US

IV. Provider business mailing address

PO BOX 371951
LAS VEGAS NV
89137-1951
US

V. Phone/Fax

Practice location:
  • Phone: 702-614-1792
  • Fax: 702-933-0190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7931
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: