Healthcare Provider Details

I. General information

NPI: 1730945148
Provider Name (Legal Business Name): KIM AND SEONG DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR STE 105
PLAINVIEW NY
11803-1707
US

IV. Provider business mailing address

255 EXECUTIVE DR STE 105
PLAINVIEW NY
11803-1707
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-8372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEVEN KIM
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 516-350-8372