MEDICARE: KIM KISHIN GANDHI, D.D.S., P.A.

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	1223P0300X	Periodontics	11592	FL

General Provider Information

NPI Number	:	1356460083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIM KISHIN GANDHI, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	2247 PALM BEACH LAKES BLVD
Second Line	:	# 207
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3470
Country	:	US
Telephone Number	:	561-242-2861
Fax Number	:	561-242-2833

Provider Business Practice Location Address
First Line	:	2247 PALM BEACH LAKES BLVD
Second Line	:	# 207
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3470
Country	:	US
Telephone Number	:	561-242-2861
Fax Number	:	561-242-2833

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KIM KISHIN GANDHI
Credential	:	D.D.S
Telephone Number	:	561-242-2861

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	11/20/2024

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