MEDICARE: DR. YOO JIN 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	51093	CA
2	1223G0001X	General Practice Dentistry	DE00010611	WA

General Provider Information

NPI Number	:	1093792194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOO JIN KIM DDS

Provider Business Mailing Address
First Line	:	11478 SILVERGATE DR
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-2753
Country	:	US
Telephone Number	:	925-833-0546
Fax Number	:

Provider Business Practice Location Address
First Line	:	15301 WASHINGTON AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94579-1811
Country	:	US
Telephone Number	:	510-351-6820
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	12/05/2011

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