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General NPI Number Information
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NPI Number | 1912076738
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Entity Type | Individual
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Provider Name | SONGHYON KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 12033 AGENCY RD
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City | PARKER
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State | AZ
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Zip | 85344-7718
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Country | US
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Telephone | 928-669-2137
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Fax | 928-669-3131
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Provider Business Mailing Address
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Address Line | PO BOX 95461
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City | CLEVELAND
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State | OH
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Zip | 44101-0033
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Country | US
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Telephone | 928-669-2137
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Fax | 928-669-3131
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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 | 30.025304
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License Number State | OH
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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 | D10160
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 265201
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 265201-9923
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License Number State | UT
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