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General NPI Number Information
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NPI Number | 1881486629
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Entity Type | Individual
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Provider Name | EDWARD JAEMIN KIM DMD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1205 BROADWAY
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City | LORAIN
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State | OH
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Zip | 44052-3409
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Country | US
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Telephone | 440-240-1655
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Fax |
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Provider Business Mailing Address
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Address Line | 10001 CHESTER AVE APT 240
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City | CLEVELAND
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State | OH
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Zip | 44106-1664
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Country | US
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Telephone | 206-973-6253
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.027997
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License Number State | OH
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