MEDICARE: DR. JONG KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5500	NV

General Provider Information

NPI Number	:	1104079680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONG KIM

Provider Business Mailing Address
First Line	:	9073 W POST RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9073 W POST RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2413
Country	:	US
Telephone Number	:	702-262-0240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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Directions to “ DR. JONG KIM ” Practice Location

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