Provider Demographics
NPI:1861226714
Name:JUNGHWAN KIM, DMD, P.C.
Entity type:Organization
Organization Name:JUNGHWAN KIM, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JUNGHWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-920-1154
Mailing Address - Street 1:1250 S MICHIGAN AVE APT 906
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2544
Mailing Address - Country:US
Mailing Address - Phone:630-920-1154
Mailing Address - Fax:
Practice Address - Street 1:1250 S MICHIGAN AVE APT 906
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2544
Practice Address - Country:US
Practice Address - Phone:630-920-1154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental