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General NPI Number Information
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NPI Number | 1851023626
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Entity Type | Individual
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Provider Name | DAEJIN KIM DMD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 07/09/2022
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Provider Practice Location Address
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Address Line | 34 CHURCH HILL RD
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City | NEWTOWN
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State | CT
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Zip | 06470-1642
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Country | US
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Telephone | 443-240-6382
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Fax |
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Provider Business Mailing Address
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Address Line | 100 OAKVIEW DR UNIT 3-102
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City | TRUMBULL
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State | CT
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Zip | 06611-4769
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Country | US
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Telephone | 443-240-6382
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 13488
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License Number State | CT
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