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General NPI Number Information
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NPI Number | 1265879019
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Entity Type | Organization
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Legal Business Name | DR. SEAN KIM DDS MD PLLC
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 1800 W 26TH ST STE 205
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City | HOUSTON
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State | TX
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Zip | 77008-1450
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Country | US
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Telephone | 832-831-8655
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Fax | 832-581-2253
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Provider Business Mailing Address
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Address Line | 1800 W 26TH ST STE 205
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City | HOUSTON
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State | TX
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Zip | 77008-1450
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Country | US
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Telephone | 832-831-8655
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Fax | 832-581-2253
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SEAN KIM
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Credential | DDS,MD
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Telephone | 832-831-8655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 23210
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License Number State | TX
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