Provider Demographics
NPI:1902094261
Name:KIM, RANAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANAH
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-5776
Mailing Address - Country:US
Mailing Address - Phone:610-525-8485
Mailing Address - Fax:610-525-8602
Practice Address - Street 1:1201 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2636
Practice Address - Country:US
Practice Address - Phone:610-525-8485
Practice Address - Fax:610-525-8602
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358501223G0001X, 1223P0300X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics