MEDICARE: DR. BORA KIM DMD

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	1223P0221X	Pediatric Dentistry	DE60876116	WA
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437686920	OTHER		NPI

General Provider Information

NPI Number	:	1437686920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BORA KIM DMD

Provider Business Mailing Address
First Line	:	1019 BEATY BLVD STE 600
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-4765
Country	:	US
Telephone Number	:	615-989-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 BEATY BLVD STE 600
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-4765
Country	:	US
Telephone Number	:	615-989-6611
Fax Number	:

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

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	01/14/2023

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