MEDICARE: DR. JAE YOUN 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	122300000X	Dentist	46085	CA

General Provider Information

NPI Number	:	1447333943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAE YOUN KIM D.D.S

Provider Business Mailing Address
First Line	:	7124 EASTERN AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-3906
Country	:	US
Telephone Number	:	323-773-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	7124 EASTERN AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-3906
Country	:	US
Telephone Number	:	323-773-3330
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/23/2021

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