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General NPI Number Information
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NPI Number | 1992359954
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Entity Type | Individual
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Provider Name | MOOCHAN KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 610 DR CALVIN JONES HWY STE 100
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City | WAKE FOREST
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State | NC
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Zip | 27587-3104
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Country | US
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Telephone | 919-336-5230
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 VIOLET FIELDS WAY UNIT 218
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City | RALEIGH
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State | NC
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Zip | 27612-5660
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Country | US
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Telephone | 917-421-0997
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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 | 22DI02925300
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License Number State | NJ
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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 | 019.032304
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License Number State | IL
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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 | 062241
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 13969
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License Number State | NC
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