MEDICARE: SUNG K KIM D.D.S.

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	10039	CO
2	1223X0008X	Oral and Maxillofacial Radiology Dentistry	36845	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10039	OTHER	CO	LICENSE

General Provider Information

NPI Number	:	1093042749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNG K KIM D.D.S.

Provider Business Mailing Address
First Line	:	7500 CAMBRIDGE ST # 5367
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2032
Country	:	US
Telephone Number	:	713-486-4417
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 CAMBRIDGE ST # 5367
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2032
Country	:	US
Telephone Number	:	713-486-4417
Fax Number	:

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

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	03/11/2021

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Directions to “ SUNG K KIM D.D.S.” Practice Location

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