MEDICARE: ISAAC KIM DMD

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	DEN4902	ME

General Provider Information

NPI Number	:	1538731799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC KIM DMD

Provider Business Mailing Address
First Line	:	32 GOLD ST
Second Line	:
City	:	WATERVILLE
State	:	ME
Zip	:	04901-5919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 OLD POINT AVE
Second Line	:
City	:	MADISON
State	:	ME
Zip	:	04950-1114
Country	:	US
Telephone Number	:	207-696-4681
Fax Number	:

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

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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