Provider Demographics
NPI:1528408200
Name:KIM, EUI SEOP
Entity type:Individual
Prefix:DR
First Name:EUI SEOP
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N EARL RUDDER FWY
Mailing Address - Street 2:#100
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2930
Mailing Address - Country:US
Mailing Address - Phone:979-774-9999
Mailing Address - Fax:
Practice Address - Street 1:910 N EARL RUDDER FWY
Practice Address - Street 2:#100
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2930
Practice Address - Country:US
Practice Address - Phone:979-774-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109771223G0001X
TX319401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice