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General NPI Number Information
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NPI Number | 1336215979
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Entity Type | Individual
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Provider Name | SUSAN KIM DDS
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4534 W GATE BLVD SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78745-1485
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Country | US
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Telephone | 512-892-5988
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Fax | 512-892-4064
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Provider Business Mailing Address
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Address Line | 3701 KIRBY DR SUITE 550
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City | HOUSTON
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State | TX
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Zip | 77098-3900
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Country | US
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Telephone | 512-892-5988
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Fax | 512-892-4064
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17206
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License Number State | TX
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