Provider Demographics
NPI:1679886097
Name:KIM, ELBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:ELBERT
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROCKEFELLER PLZ
Mailing Address - Street 2:#2203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ROCKEFELLER PLZ
Practice Address - Street 2:#2203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-2003
Practice Address - Country:US
Practice Address - Phone:212-679-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049944-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics