MEDICARE: DR. ELIES 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	101559	CA

General Provider Information

NPI Number	:	1124540703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIES KIM D.D.S.

Provider Business Mailing Address
First Line	:	1518 E LINCOLN AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-1928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 E LINCOLN AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-1928
Country	:	US
Telephone Number	:	657-282-0078
Fax Number	:

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

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	02/24/2024

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