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General NPI Number Information
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NPI Number | 1871979427
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Entity Type | Individual
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Provider Name | WOOSOL KIM D.M.D
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Gender | Male
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 1067 TWINING DR
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City | BARKSDALE AFB
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State | LA
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Zip | 71110-2486
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Country | US
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Telephone | 318-456-6718
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Fax |
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Provider Business Mailing Address
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Address Line | 1067 TWINING DR
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City | BARKSDALE AFB
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State | LA
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Zip | 71110-2486
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Country | US
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Telephone | 609-754-3786
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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 | 0401414964
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 33132
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License Number State | TX
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