MEDICARE: PAUL MINSIK 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	122300000X	Dentist	DN015656	GA

General Provider Information

NPI Number	:	1609369131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MINSIK KIM DMD

Provider Business Mailing Address
First Line	:	4710 SIERRA CREEK DR
Second Line	:
City	:	HOSCHTON
State	:	GA
Zip	:	30548-6368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 BRASELTON HWY STE 104
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-4672
Country	:	US
Telephone Number	:	770-945-2733
Fax Number	:

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

Provider Enumeration Date	:	06/09/2018
Last Update Date	:	08/07/2024

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Directions to “ PAUL MINSIK KIM DMD” Practice Location

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