MEDICARE: ERIC N. KIM, DDS, PC

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	8001	OR

General Provider Information

NPI Number	:	1851447817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC N. KIM, DDS, PC

Provider Business Mailing Address
First Line	:	8900 SW HALL BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-4493
Country	:	US
Telephone Number	:	503-644-2446
Fax Number	:	503-641-8696

Provider Business Practice Location Address
First Line	:	8900 SW HALL BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-4493
Country	:	US
Telephone Number	:	503-644-2446
Fax Number	:	503-641-8696

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC N KIM
Credential	:	DDS
Telephone Number	:	503-644-2446

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	12/18/2009

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