MEDICARE: JEONG YEON KIM DDS

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	41696	TX

General Provider Information

NPI Number	:	1528762044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEONG YEON KIM DDS

Provider Business Mailing Address
First Line	:	4820 ZILKER AVE
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	398 E FM 1382 STE B
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-6056
Country	:	US
Telephone Number	:	972-291-6262
Fax Number	:

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	01/23/2026

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Directions to “ JEONG YEON KIM DDS” Practice Location

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