MEDICARE: HYUNGSOO KIM, D.M.D., P.C.

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	261QD0000X	Dental Clinic/Center	22DI02428000	NJ

General Provider Information

NPI Number	:	1063716991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYUNGSOO KIM, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	3495 US HIGHWAY 1
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5933
Country	:	US
Telephone Number	:	609-936-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	3495 US HIGHWAY 1
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5933
Country	:	US
Telephone Number	:	609-936-0040
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. HYUNGSOO KIM
Credential	:	D.M.D.
Telephone Number	:	908-202-3405

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	01/06/2011

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