MEDICARE: DALE KIM DDS

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	00202690	CO

General Provider Information

NPI Number	:	1053784207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE KIM DDS

Provider Business Mailing Address
First Line	:	2020 S PARKER RD UNIT F
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 S PARKER RD UNIT F
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-5724
Country	:	US
Telephone Number	:	720-477-1449
Fax Number	:

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	09/20/2021

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