Provider Demographics
NPI:1144956764
Name:KIM, HYEON SEOK (DDS)
Entity type:Individual
Prefix:
First Name:HYEON
Middle Name:SEOK
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 1:313 WROTHAM LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2971
Mailing Address - Country:US
Mailing Address - Phone:972-697-1606
Mailing Address - Fax:
Practice Address - Street 1:8942 S BROADWAY AVE STE 128
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5443
Practice Address - Country:US
Practice Address - Phone:903-405-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX388061223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice