Provider Demographics
NPI:1023405305
Name:KIM, GRACE EUNHEH (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:EUNHEH
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MOUNT HERMON RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5219
Mailing Address - Country:US
Mailing Address - Phone:410-202-8500
Mailing Address - Fax:410-202-8507
Practice Address - Street 1:1301 MOUNT HERMON RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5219
Practice Address - Country:US
Practice Address - Phone:410-202-8500
Practice Address - Fax:410-202-8507
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168731223G0001X
TX34387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid