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NPI Code Detail

MEDICARE: DR. MIN C. KIM DMD

MEDICARE: DR. MIN C. KIM DMD
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
11223G0001XGeneral Practice Dentistry051705NY
21223P0221XPediatric Dentistry051705NY

General Provider Information

NPI Number : 1912107194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIN C. KIM DMD
Provider Business Mailing Address
First Line : 4270 GORGAS CIRCLE
Second Line : ATTN: ROBERTA DRISKILL
City : FORT SAM HOUSTON
State : TX
Zip : 78234-2639
Country : US
Telephone Number : 210-221-6326
Fax Number :
Provider Business Practice Location Address
First Line : 3145 GARDEN AVE STE 1278
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-7719
Country : US
Telephone Number : 210-808-3735
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2007
Last Update Date : 01/30/2024

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