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General NPI Number Information
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NPI Number | 1073807103
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Entity Type | Individual
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Provider Name | SEAN SHIN KIM
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Gender | Male
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 152 N WELLWOOD AVE
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City | LINDENHURST
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State | NY
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Zip | 11757-4046
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Country | US
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Telephone | 631-226-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 426 PLATEAU AVE # 2
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City | FORT LEE
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State | NJ
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Zip | 07024-1726
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Country | US
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Telephone | 201-600-6704
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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 | 056133
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License Number State | NY
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