Provider Demographics
NPI:1053112144
Name:KIM, KEUN HWAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEUN HWAN
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:40 PIEDMONT DR.
Mailing Address - Street 2:APT1-7A
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:415-688-9319
Mailing Address - Fax:
Practice Address - Street 1:40 PIEDMONT DR.
Practice Address - Street 2:APT1-7A
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:415-688-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program