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General NPI Number Information
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NPI Number | 1174806525
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Entity Type | Individual
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Provider Name | PAUL JOON KIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 514 FULTON AVE
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City | HEMPSTEAD
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State | NY
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Zip | 11550-4364
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Country | US
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Telephone | 516-485-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 14022 BEECH AVE APT 3G
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City | FLUSHING
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State | NY
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Zip | 11355-2822
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Country | US
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Telephone | 609-412-2813
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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 | 055829
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License Number State | NY
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