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General NPI Number Information
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NPI Number | 1083096713
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Entity Type | Organization
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Legal Business Name | KWON-KIM DDS PLLC
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 4112 EAST RENNER RD.
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City | RICHARDSON
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State | TX
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Zip | 75082
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Country | US
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Telephone | 972-480-0800
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Fax | 972-480-0900
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Provider Business Mailing Address
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Address Line | 4112 EAST RENNER RD.
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City | RICHARDSON
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State | TX
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Zip | 75082
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Country | US
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Telephone | 972-480-0800
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Fax | 972-480-0900
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Authorized Official
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Title or Position | PRESIDENT
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Name | JINSOO KIM
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Credential | DDS
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Telephone | 972-480-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 28842
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License Number State | TX
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