Individual
DR. KOOK KAN KIM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5438 N LAWRENCE ST, PHILADELPHIA, PA 19120-2804
(215) 224-2110
(215) 224-6452
Mailing address
5438 N LAWRENCE ST, PHILADELPHIA, PA 19120-2804
(215) 224-2110
(215) 224-6452
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0022669
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010238
AETNA PROVIDER NUMBER
PA
Enumeration date
06/09/2006
Last updated
07/08/2007
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