=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356460083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIM KISHIN GANDHI, D.D.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 11/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2247 PALM BEACH LAKES BLVD # 207
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-3470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-242-2861
-----------------------------------------------------
Fax | 561-242-2833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2247 PALM BEACH LAKES BLVD # 207
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-3470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-242-2861
-----------------------------------------------------
Fax | 561-242-2833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. KIM KISHIN GANDHI
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 561-242-2861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 11592
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------