Provider Demographics
NPI:1043729304
Name:KUM, JOHN MINWOO (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MINWOO
Last Name:KUM
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 1:1401 AIRPORT PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1522
Mailing Address - Country:US
Mailing Address - Phone:307-632-4574
Mailing Address - Fax:
Practice Address - Street 1:1401 AIRPORT PKWY STE 110
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1522
Practice Address - Country:US
Practice Address - Phone:307-632-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16361223P0300X
PADS0415301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty