Provider Demographics
NPI:1124703285
Name:KIM, JEFFREY SUNGJOON (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SUNGJOON
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 1:3410 NIXON RD UNIT 320
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2450
Mailing Address - Country:US
Mailing Address - Phone:703-635-6825
Mailing Address - Fax:
Practice Address - Street 1:2725 S MILFORD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4945
Practice Address - Country:US
Practice Address - Phone:248-685-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014185181223G0001X
MI29016023871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice