Provider Demographics
NPI:1144494840
Name:KIM, ALDEN KYU (DMD)
Entity type:Individual
Prefix:
First Name:ALDEN
Middle Name:KYU
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1156
Mailing Address - Country:US
Mailing Address - Phone:856-456-0164
Mailing Address - Fax:856-456-7683
Practice Address - Street 1:27 N BROADWAY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1156
Practice Address - Country:US
Practice Address - Phone:856-456-0164
Practice Address - Fax:856-456-7683
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019008001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI01900800OtherDEA# BK4217267