Organization
THIRD AVENUE BRONX DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUNG KWANG KIM DDS (OWNER)
(718) 618-0162
Entity
Organization
Contact information
Practice address
2740 3RD AVE, BRONX, NY 10455-4036
(718) 618-0162
(718) 618-0173
Mailing address
2740 3RD AVE, BRONX, NY 10455-4036
(718) 618-0162
(718) 618-0173
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05315619
—
NY
Enumeration date
01/29/2019
Last updated
01/29/2019
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