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General NPI Number Information
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NPI Number | 1316136146
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Entity Type | Individual
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Provider Name | JEFFREY H KIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 1231 WEBSTER AVE
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City | BRONX
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State | NY
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Zip | 10456-3373
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Country | US
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Telephone | 646-402-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 248 COLUMBIA AVE APT 1
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City | LODI
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State | NJ
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Zip | 07644-3824
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Country | US
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Telephone | 646-456-5243
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0527581
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License Number State | NY
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