=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851389225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE JUNG KIM DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8575 E PRINCESS DR SUITE 217
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-342-8200
-----------------------------------------------------
Fax | 480-342-8008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8575 E PRINCESS DR SUITE 217
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-342-8200
-----------------------------------------------------
Fax | 480-342-8008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 9251
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------