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General NPI Number Information
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NPI Number | 1023219045
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Entity Type | Individual
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Provider Name | SUNG H KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 14936 NORTHERN BLVD #201
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City | FLUSHING
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State | NY
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Zip | 11354-3884
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Country | US
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Telephone | 718-888-9446
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Fax |
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Provider Business Mailing Address
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Address Line | 14936 NORTHERN BLVD #201
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City | FLUSHING
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State | NY
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Zip | 11354-3884
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Country | US
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Telephone | 718-888-9446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI01885700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 045175
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License Number State | NY
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