Individual
RODERICK YOUNGDO KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
1500 S MAIN ST DEPT OF, FORT WORTH, TX 76104-4917
(817) 702-6936
Mailing address
1500 SOUTH MAIN, DEPARTMENT OF OMFS, FORT WORTH, TX 76104
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
32838
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
32838
TX
Other
Enumeration date
08/23/2011
Last updated
06/26/2024
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