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General NPI Number Information
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NPI Number | 1720218910
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Entity Type | Individual
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Provider Name | JOHN Y KIM
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Gender | Male
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 1936 COTTMAN AVE
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City | PHILA
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State | PA
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Zip | 19111-3800
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Country | US
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Telephone | 215-728-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 921 FANSHAWE ST
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City | PHILA
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State | PA
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Zip | 19111-4801
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Country | US
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Telephone | 215-779-6957
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Fax | 215-695-0622
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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 | DS024115L
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License Number State | PA
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