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General NPI Number Information
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NPI Number | 1467783092
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Entity Type | Organization
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Legal Business Name | HJ KIM DDS, PA
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 9501 OLD ANNAPOLIS RD STE. 200 A
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-6314
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Country | US
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Telephone | 410-740-1484
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Fax | 410-740-1486
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Provider Business Mailing Address
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Address Line | 9501 OLD ANNAPOLIS RD STE. 200 A
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-6314
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Country | US
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Telephone | 410-740-1484
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Fax | 410-740-1486
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEEJUNG KIM
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Credential |
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Telephone | 410-740-1484
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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 | 13733
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 13733
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 13733
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13733
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License Number State | MD
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