MEDICARE: DR. SANGKYU STEVE 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	16433	TX

General Provider Information

NPI Number	:	1265658363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANGKYU STEVE KIM D.D.S.

Provider Business Mailing Address
First Line	:	2527 ROYAL LN
Second Line	:	#137
City	:	DALLAS
State	:	TX
Zip	:	75229-3485
Country	:	US
Telephone Number	:	972-247-8606
Fax Number	:

Provider Business Practice Location Address
First Line	:	2527 ROYAL LN
Second Line	:	#137
City	:	DALLAS
State	:	TX
Zip	:	75229-3485
Country	:	US
Telephone Number	:	972-247-8606
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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