MEDICARE: DR. ESTHER INSUN 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	019-022223	IL

General Provider Information

NPI Number	:	1306910591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESTHER INSUN KIM D.D.S.

Provider Business Mailing Address
First Line	:	5830 DEMPSTER ST
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3029
Country	:	US
Telephone Number	:	847-965-6878
Fax Number	:

Provider Business Practice Location Address
First Line	:	3224 W BRYN MAWR AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3606
Country	:	US
Telephone Number	:	773-463-1212
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	03/23/2016

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