MEDICARE: DR. EDWARD YUNGJUNG KIM 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	3357	NV

General Provider Information

NPI Number	:	1982779013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD YUNGJUNG KIM DDS

Provider Business Mailing Address
First Line	:	5205 S DURANGO DR STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0179
Country	:	US
Telephone Number	:	702-384-2828
Fax Number	:	702-889-1118

Provider Business Practice Location Address
First Line	:	5205 S. DURANGO DR. #103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113
Country	:	US
Telephone Number	:	702-384-2828
Fax Number	:	702-889-1118

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	06/06/2012

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