Provider Demographics
NPI:1164815759
Name:KIM, WILLIAM S (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
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 1:51685 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4449
Mailing Address - Country:US
Mailing Address - Phone:586-924-2038
Mailing Address - Fax:586-323-1644
Practice Address - Street 1:51685 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4449
Practice Address - Country:US
Practice Address - Phone:586-924-2038
Practice Address - Fax:586-323-1644
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016007831223S0112X, 122300000X, 1223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program