MEDICARE: DR. SOOYONG 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	122300000X	Dentist	56461	CA

General Provider Information

NPI Number	:	1063698629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOOYONG KIM DDS

Provider Business Mailing Address
First Line	:	3307 ALTA ARDEN EXPY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2102
Country	:	US
Telephone Number	:	916-974-1819
Fax Number	:	916-974-7568

Provider Business Practice Location Address
First Line	:	3307 ALTA ARDEN EXPY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2102
Country	:	US
Telephone Number	:	916-974-1819
Fax Number	:	916-974-7568

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

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	12/26/2023

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Directions to “ DR. SOOYONG KIM DDS” Practice Location

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