Stephan Seok Kim, D.M.D.
Individual provider Active NPI Dentist · Apo, CA
NPI 1285033704 · NPPES record last updated Oct 20, 2022
Key facts
- NPI
- 1285033704
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS040117 (PA)
- Practice address
- Brian D. Allgood Army Community Hospital (Bdaach)
Unit #15245
Apo, CA 96271 - Phone
- (315) 737-9187
- NPI assigned
- Aug 20, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02584000 | NJ | MD | Dentist |
| DS040117 | PA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02584000 | NJ | |
| Dentist | 122300000X | DS040117 | PA | Yes |
Addresses
Primary practice location
Brian D. Allgood Army Community Hospital (Bdaach)
Unit #15245
Apo, CA 96271
Mailing address
PSC 444 Box 824
Apo, AP 96297-0009
Phone (315) 737-9187
Other providers in Apo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.