Provider Demographics
NPI:1043434483
Name:KIM, STEPHEN HOJONG (DDS, MS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:HOJONG
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 COPPER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3777
Mailing Address - Country:US
Mailing Address - Phone:410-564-7492
Mailing Address - Fax:
Practice Address - Street 1:4061 KIRKPATRICK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-355-2424
Practice Address - Fax:972-355-2426
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25299122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist