MEDICARE: HYUNG T 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	1223G0001X	General Practice Dentistry	55714	CA

General Provider Information

NPI Number	:	1164859096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYUNG T KIM DDS INC.

Provider Business Mailing Address
First Line	:	130 W. ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3113
Country	:	US
Telephone Number	:	310-893-9794
Fax Number	:	213-251-8909

Provider Business Practice Location Address
First Line	:	130 W. ANAHEIM STREET
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3113
Country	:	US
Telephone Number	:	310-893-9794
Fax Number	:	213-251-8909

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HYUNG T KIM
Credential	:	D.D.S
Telephone Number	:	310-893-9794

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	10/10/2013

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