Individual
KI BEOM KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MSD, PHD
Contact information
Practice address
3200 S UNIVERSITY DR, DAVIE, FL 33328-2018
(954) 262-1755
Mailing address
3200 S UNIVERSITY DR, DAVIE, FL 33328-2018
(954) 262-1755
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
TEACHING PERMIT
FL
Other
Enumeration date
08/31/2011
Last updated
08/31/2011
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