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General NPI Number Information
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NPI Number | 1245868579
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Entity Type | Individual
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Provider Name | DAVID KIM
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 357 S GULPH RD STE 110
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3174
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Country | US
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Telephone | 610-337-2325
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Fax |
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Provider Business Mailing Address
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Address Line | 140 VALLEY GREEN LN UNIT W-2410
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2295
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Country | US
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Telephone | 610-955-7731
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS043466
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License Number State | PA
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