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General NPI Number Information
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NPI Number | 1689170318
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Entity Type | Organization
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Legal Business Name | MI DENTAL PC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 1006 S ELMHURST RD
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City | MT PROSPECT
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State | IL
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Zip | 60056-4240
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Country | US
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Telephone | 646-761-5224
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Fax |
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Provider Business Mailing Address
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Address Line | 39 ORRINGTON CT
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City | SCHAUMBURG
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State | IL
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Zip | 60173-2116
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Country | US
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Telephone | 646-761-5224
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HYUN MIN KIM
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Credential | DDS
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Telephone | 646-761-5224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019028417
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028417
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License Number State | IL
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