MEDICARE: DR. MAX H 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	6002091-15	WI

General Provider Information

NPI Number	:	1285623470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAX H KIM D.D.S.

Provider Business Mailing Address
First Line	:	8501 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3504
Country	:	US
Telephone Number	:	773-284-2241
Fax Number	:	773-284-1996

Provider Business Practice Location Address
First Line	:	8501 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3504
Country	:	US
Telephone Number	:	773-284-2241
Fax Number	:	773-284-1996

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	04/28/2026

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