MEDICARE: KIM & AU-YEUNG DENTISTRY, P.C.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336618503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM & AU-YEUNG DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	8354 LITTLE EAGLE CT STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-3822
Country	:	US
Telephone Number	:	317-209-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8354 LITTLE EAGLE CT STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-3822
Country	:	US
Telephone Number	:	317-540-3982
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/CO-OWNER
Name	:	DR. YOUNG EUN KIM
Credential	:	DDS
Telephone Number	:	317-540-3982

Provider Enumeration Date	:	11/17/2018
Last Update Date	:	11/17/2018

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