Individual
DR. HEE SOO KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
430 MAIN ST, GREEN BAY, WI 54301-5115
(920) 431-0345
Mailing address
400 E WAYFARER LN, APPLETON, WI 54913-6358
(920) 954-8633
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5052-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33752700
—
WI
Enumeration date
08/24/2006
Last updated
07/08/2007
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