Provider Demographics
NPI:1861057044
Name:HODIAH DMD LLC
Entity type:Organization
Organization Name:HODIAH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HYOUNG KEUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:667-200-5912
Mailing Address - Street 1:6100 DAYLONG LN STE 204
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1655
Mailing Address - Country:US
Mailing Address - Phone:667-200-5912
Mailing Address - Fax:443-546-3330
Practice Address - Street 1:6100 DAYLONG LN STE 204
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1655
Practice Address - Country:US
Practice Address - Phone:667-200-5912
Practice Address - Fax:443-546-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty