MEDICARE: DR. MARIE KIM

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	D102811	CA

General Provider Information

NPI Number	:	1144753260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE KIM

Provider Business Mailing Address
First Line	:	3054 W 8TH ST STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1895
Country	:	US
Telephone Number	:	213-387-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 W 8TH ST STE 106
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1895
Country	:	US
Telephone Number	:	213-387-2864
Fax Number	:

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	01/03/2026

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Directions to “ DR. MARIE KIM ” Practice Location

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