Provider Demographics
NPI:1710482195
Name:KIM, JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
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 1:110 E 40TH ST RM 102
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1807
Mailing Address - Country:US
Mailing Address - Phone:212-683-8288
Mailing Address - Fax:
Practice Address - Street 1:110 E 40TH ST RM 102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1807
Practice Address - Country:US
Practice Address - Phone:212-683-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2025-09-26
Deactivation Date:2020-05-25
Deactivation Code:
Reactivation Date:2020-06-02
Provider Licenses
StateLicense IDTaxonomies
NY0629201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty