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General NPI Number Information
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NPI Number | 1730884560
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Entity Type | Individual
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Provider Name | DONGSU KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1799 N WILLIAMSON BLVD APT 7210
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5309
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Country | US
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Telephone | 804-937-9680
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Fax |
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Provider Business Mailing Address
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Address Line | 311 E 25TH ST APT 5F
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City | NEW YORK
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State | NY
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Zip | 10010-2501
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Country | US
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Telephone | 804-937-9680
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN28875
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License Number State | FL
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