MEDICARE: JOANNE SUNG 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	57828	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57828	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1356593347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE SUNG KIM DDS

Provider Business Mailing Address
First Line	:	7601 SEVILLE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-6029
Country	:	US
Telephone Number	:	323-587-6600
Fax Number	:	323-584-1778

Provider Business Practice Location Address
First Line	:	7601 SEVILLE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-6029
Country	:	US
Telephone Number	:	323-587-6600
Fax Number	:	323-584-1778

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	09/27/2010

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