MEDICARE: YONG KIM, 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	1223E0200X	Endodontics	S7-75	NV

General Provider Information

NPI Number	:	1851672158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YONG KIM, PC

Provider Business Mailing Address
First Line	:	2575 S CIMARRON RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7653
Country	:	US
Telephone Number	:	702-369-7441
Fax Number	:

Provider Business Practice Location Address
First Line	:	2575 S CIMARRON RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7653
Country	:	US
Telephone Number	:	702-369-7441
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	YONG KIM
Credential	:	DDS
Telephone Number	:	702-612-2712

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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