MEDICARE: DR. JAIBUM KIM DDS, MS

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	21823	TX

General Provider Information

NPI Number	:	1457529331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIBUM KIM DDS, MS

Provider Business Mailing Address
First Line	:	2717 COMMERCIAL CENTER BLVD
Second Line	:	SUITE J220
City	:	KATY
State	:	TX
Zip	:	77494-6410
Country	:	US
Telephone Number	:	281-394-2520
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 COMMERCIAL CENTER BLVD
Second Line	:	SUITE J220
City	:	KATY
State	:	TX
Zip	:	77494-6410
Country	:	US
Telephone Number	:	281-394-2520
Fax Number	:

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

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/07/2024

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