Provider Demographics
NPI:1861238024
Name:KIM, HAEMIN HAILEY (DDS)
Entity type:Individual
Prefix:DR
First Name:HAEMIN
Middle Name:HAILEY
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3788 RICHMOND AVE APT 1306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3712
Mailing Address - Country:US
Mailing Address - Phone:469-387-5510
Mailing Address - Fax:
Practice Address - Street 1:14570 WALLISVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4351
Practice Address - Country:US
Practice Address - Phone:713-453-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice