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General NPI Number Information
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NPI Number | 1851710511
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Entity Type | Organization
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Legal Business Name | 123 DENTAL GROUP PC
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 123 E 37TH ST SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10016-3030
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Country | US
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Telephone | 212-686-1115
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Fax | 212-686-1142
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Provider Business Mailing Address
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Address Line | 123 E 37TH ST SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10016-3030
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Country | US
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Telephone | 212-686-1115
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Fax | 212-686-1142
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Authorized Official
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Title or Position | PRESIDENT
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Name | HYO-JIN KIM
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Credential | DDS
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Telephone | 212-686-1115
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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 | 055884
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License Number State | NY
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