Individual
DR. DONGSOO DAVID KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF ORAL SURGERY, SHREVEPORT, LA 71103-4228
(318) 813-2625
(318) 813-2627
Mailing address
1501 KINGS HWY, DEPARTMENT OF ORAL SURGERY, SHREVEPORT, LA 71103-4228
(318) 813-2625
(318) 813-2627
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
5542
LA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
15055R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1855421
—
LA
Enumeration date
07/17/2006
Last updated
08/25/2021
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