MEDICARE: NABIYA DENTAL, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104154640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NABIYA DENTAL, PLLC

Provider Business Mailing Address
First Line	:	8514 BELLAIRE BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	77036-4704
Country	:	US
Telephone Number	:	713-779-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8514 BELLAIRE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-4704
Country	:	US
Telephone Number	:	713-779-6900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN KIM
Credential	:	DDS
Telephone Number	:	713-668-3677

Provider Enumeration Date	:	11/20/2009
Last Update Date	:	11/20/2009

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