MEDICARE: DR. JIN YOUNG KIM DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	58103	CA

General Provider Information

NPI Number	:	1629209341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIN YOUNG KIM DDS, MS

Provider Business Mailing Address
First Line	:	5811 PINE AVE STE B
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6541
Country	:	US
Telephone Number	:	909-393-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5811 PINE AVE STE B
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6541
Country	:	US
Telephone Number	:	909-393-4800
Fax Number	:	888-393-0564

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	09/28/2018

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