| Doctor Name: | BONGOK KIM |
| NPI Number: | 1003193152 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6993 |
| Business Practice Address: | 3885 Holdrege St. Lincoln, NE - 685830740 |
| Business Phone Number: | 4024728900 |
| Business Fax Number: | |
| Mailing Address: | Pobox 830740, LINCOLN |
| State: | NE |
| Postal Code: | 685830740 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2011 |
| NPI Last Update Date: | 11/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0700X |
| License Number: | 6993 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Prosthodontics |
| Taxonomy Definition: | That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |