MEDICARE: DR. SOJIN KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30347	TX

General Provider Information

NPI Number	:	1003224684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOJIN KIM

Provider Business Mailing Address
First Line	:	2630 BISSONNET ST APT 4110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1347
Country	:	US
Telephone Number	:	412-482-0902
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 ALDINE MAIL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-4644
Country	:	US
Telephone Number	:	381-617-1038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	07/28/2014

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