MEDICARE: MEEYOUNG JULIE KIM, DDS, INC

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	1223P0700X	Prosthodontics	49907	CA

General Provider Information

NPI Number	:	1144755075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEEYOUNG JULIE KIM, DDS, INC

Provider Business Mailing Address
First Line	:	437 W COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1537
Country	:	US
Telephone Number	:	818-244-0299
Fax Number	:	818-244-0297

Provider Business Practice Location Address
First Line	:	437 W COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1537
Country	:	US
Telephone Number	:	818-244-0299
Fax Number	:	818-244-0297

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MEEYOUNG JULIE KIM
Credential	:	D.D.S.
Telephone Number	:	818-244-0299

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	04/28/2017

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