MEDICARE: DR. JI IN 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	57816	CA
2	122300000X	Dentist	6120	NV

General Provider Information

NPI Number	:	1164677746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JI IN KIM D.D.S.

Provider Business Mailing Address
First Line	:	150 E CENTENNIAL PKWY STE 113
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1338
Country	:	US
Telephone Number	:	702-642-1386
Fax Number	:	702-642-6321

Provider Business Practice Location Address
First Line	:	150 E CENTENNIAL PKWY STE 113
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084
Country	:	US
Telephone Number	:	702-642-1386
Fax Number	:	702-642-6321

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	04/24/2019

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1962505875 — DAVID CHUNG DDS
Practice Location Address:

6885 ALIANTE PKWY. , 111
N. LAS VEGAS, NV
89084

Practice Phone: 702-515-1888
Practice Fax:

1962501445 — WAL-MART STORES, INC.
Practice Location Address:

6464 N. DECATUR BLVD.
NORTH LAS VEGAS, NV
89084

Practice Phone: 702-515-7716
Practice Fax:

1306035571 — DR. KELLY E VAN WAGNER M.D.
Practice Location Address:

6380 N. DECATUR BLVD , STE 215
N. LAS VEGAS, NV
89084

Practice Phone: 702-948-1145
Practice Fax: 702-949-6206

1376725648 — SANDRA CATHERINE TAVISORA NCTM
Practice Location Address:

6961 PUETOLLANO DR
N LAS VEGAS, NV
89084-2339

Practice Phone: 480-650-2010
Practice Fax:

1033356415 — WARM SPRINGS ROAD CVS LLC
Practice Location Address:

7090 N 5TH ST
NORTH LAS VEGAS, NV
89084-1333

Practice Phone: 702-216-4502
Practice Fax: 702-216-4512

Directions to “ DR. JI IN KIM D.D.S.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.