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General NPI Number Information
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NPI Number | 1508288606
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Entity Type | Organization
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Legal Business Name | MICHAEL J. KIM, DDS, LTD.
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 5680 W FLAMINGO RD SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89103-0169
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Country | US
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Telephone | 702-876-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 5680 W FLAMINGO RD SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89103-0169
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL JONG-GYU KIM
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Credential |
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Telephone | 213-820-1457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6486
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License Number State | NV
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