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General NPI Number Information
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NPI Number | 1144729369
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Entity Type | Organization
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Legal Business Name | I-10 DENTAL CARE SERVICE PLLC
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 13319 EAST FWY
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City | HOUSTON
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State | TX
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Zip | 77015-5801
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Country | US
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Telephone | 713-451-3333
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Fax | 713-429-4005
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Provider Business Mailing Address
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Address Line | 13319 EAST FWY
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City | HOUSTON
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State | TX
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Zip | 77015-5801
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Country | US
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Telephone | 713-451-3333
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Fax | 713-429-4005
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SEJOON SEAN KIM
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Credential | DDS,MD
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Telephone | 713-451-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23210
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License Number State | TX
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