MEDICARE: KYUNG HYUN 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	122300000X	Dentist	5653015	WI
2	1223G0001X	General Practice Dentistry	053232	NY
3	1223G0001X	General Practice Dentistry	053232-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427157940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYUNG HYUN KIM DDS

Provider Business Mailing Address
First Line	:	1 BARSTOW RD # P23
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3501
Country	:	US
Telephone Number	:	516-466-8744
Fax Number	:	516-829-3650

Provider Business Practice Location Address
First Line	:	1 BARSTOW RD # P23
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3501
Country	:	US
Telephone Number	:	516-466-8744
Fax Number	:	516-829-3650

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/04/2018

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Directions to “ KYUNG HYUN KIM DDS” Practice Location

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