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General NPI Number Information
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NPI Number | 1194238956
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Entity Type | Individual
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Provider Name | JAYUN JOANNA KIM DMD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 4920 TX-121 #200
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City | LEWISVILLE
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State | TX
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Zip | 75056
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Country | US
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Telephone | 972-300-4155
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Fax |
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Provider Business Mailing Address
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Address Line | 663 TRAIL SIDE DR
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City | LEWISVILLE
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State | TX
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Zip | 75067-7884
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Country | US
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Telephone | 502-753-9941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10038
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10038
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38358
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License Number State | TX
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