Provider Demographics
NPI:1881486629
Name:KIM, EDWARD JAEMIN (DMD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAEMIN
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 CHESTER AVE APT 240
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1664
Mailing Address - Country:US
Mailing Address - Phone:206-973-6253
Mailing Address - Fax:
Practice Address - Street 1:1205 BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3409
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0279971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice