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General NPI Number Information
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NPI Number | 1770358830
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Entity Type | Individual
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Provider Name | KYEUNG MOK KIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 602 N HAMPTON RD
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City | DESOTO
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State | TX
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Zip | 75115-4508
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Country | US
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Telephone | 972-846-0581
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 ELM ST APT 2213
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City | DALLAS
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State | TX
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Zip | 75201-5005
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Country | US
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Telephone |
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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 | 41853
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 109471
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License Number State | CA
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