MEDICARE: ALEXANDER Y 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	122300000X	Dentist	41268	CA

General Provider Information

NPI Number	:	1851415566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER Y KIM DDS MS

Provider Business Mailing Address
First Line	:	2324 MONTPELIER DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1612
Country	:	US
Telephone Number	:	408-272-1272
Fax Number	:	408-272-1289

Provider Business Practice Location Address
First Line	:	2324 MONTPELIER DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1612
Country	:	US
Telephone Number	:	408-272-1272
Fax Number	:	408-272-1289

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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