Provider Demographics
NPI:1144347238
Name:KIM, SAMUEL SANGTAEK (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SANGTAEK
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 N SPRING DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4235
Mailing Address - Country:US
Mailing Address - Phone:972-644-7756
Mailing Address - Fax:
Practice Address - Street 1:10544 WALNUT ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5308
Practice Address - Country:US
Practice Address - Phone:972-494-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice