MEDICARE: MARIE KIM DDS., INC

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

General Provider Information

NPI Number	:	1952262636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIE KIM DDS., INC

Provider Business Mailing Address
First Line	:	3054 W 8TH ST STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1895
Country	:	US
Telephone Number	:	213-384-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 W 8TH ST STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1895
Country	:	US
Telephone Number	:	213-384-2864
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	MARIE KIM
Credential	:
Telephone Number	:	213-384-2864

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	11/21/2025

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