MEDICARE: DR. JOOYOUNG KIM D.M.D

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	62597	CA

General Provider Information

NPI Number	:	1629402904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOOYOUNG KIM D.M.D

Provider Business Mailing Address
First Line	:	52 CAMELOT CT
Second Line	:
City	:	ALAMO
State	:	CA
Zip	:	94507-1747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 E EL CAMINO REAL
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3759
Country	:	US
Telephone Number	:	408-523-2828
Fax Number	:

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/27/2020

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