MEDICARE: DR. STEVEN JAE DOO KIM DMD, DDS

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	0401416720	VA
2	122300000X	Dentist	DS036939	PA
3	1223P0300X	Periodontics	DS036939	PA
4	1223P0300X	Periodontics	09617	NC

General Provider Information

NPI Number	:	1932339520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN JAE DOO KIM DMD, DDS

Provider Business Mailing Address
First Line	:	MANNING DR & COLUMBIA ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:	919-537-3737
Fax Number	:

Provider Business Practice Location Address
First Line	:	MANNING DR & COLUMBIA ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-2205
Country	:	US
Telephone Number	:	215-969-0900
Fax Number	:

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

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	02/05/2020

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