MEDICARE: DR. CHRISTINA KIM DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	061157	NY

General Provider Information

NPI Number	:	1245897032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA KIM DDS

Provider Business Mailing Address
First Line	:	380 UNION AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3429
Country	:	US
Telephone Number	:	718-736-2149
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 UNION AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-3429
Country	:	US
Telephone Number	:	718-736-2149
Fax Number	:

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	08/03/2021

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