MEDICARE: DR. CHRISTOPHER JUNG KWON KIM D.D.S

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	43802	CA

General Provider Information

NPI Number	:	1235265695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JUNG KWON KIM D.D.S

Provider Business Mailing Address
First Line	:	1002 E.EL CAMINO REAL
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087
Country	:	US
Telephone Number	:	408-523-2828
Fax Number	:	408-523-2833

Provider Business Practice Location Address
First Line	:	1002 E EL CAMINO REAL
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3759
Country	:	US
Telephone Number	:	408-523-2828
Fax Number	:	408-523-2833

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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