MEDICARE: E KIM BESTCARE DENTAL, LTD

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	3357	NV

General Provider Information

NPI Number	:	1033239694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E KIM BESTCARE DENTAL, LTD

Provider Business Mailing Address
First Line	:	5205 S DURANGO DR
Second Line	:	#103
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0159
Country	:	US
Telephone Number	:	702-384-2828
Fax Number	:	702-889-1118

Provider Business Practice Location Address
First Line	:	5205 S DURANGO DR
Second Line	:	#103
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0159
Country	:	US
Telephone Number	:	702-384-2828
Fax Number	:	702-889-1118

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD YUNGJUNG KIM
Credential	:	D.D.S.
Telephone Number	:	702-384-2828

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/21/2008

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