MEDICARE: WILLIAM DAE WON 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	1223G0001X	General Practice Dentistry	103124	CA

General Provider Information

NPI Number	:	1366923146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DAE WON KIM DDS

Provider Business Mailing Address
First Line	:	2485 QUEENSBERRY RD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-3440
Country	:	US
Telephone Number	:	213-270-5432
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-3519
Country	:	US
Telephone Number	:	323-522-3382
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	04/07/2025

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