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General NPI Number Information
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NPI Number | 1811444912
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Entity Type | Organization
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Legal Business Name | DELAWARE DENTISTRY, PAUL KIM DDS, LLC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 809 N HOUK RD
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City | DELAWARE
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State | OH
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Zip | 43015-4418
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Country | US
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Telephone | 419-309-0034
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Fax |
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Provider Business Mailing Address
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Address Line | 809 N HOUK RD
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City | DELAWARE
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State | OH
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Zip | 43015-4418
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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 | SOLE MEMBER
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Name | PAUL KIM
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Credential |
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Telephone | 419-309-0034
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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 | 30.024081
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License Number State | OH
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