MEDICARE: PAUL JUNG KIM D.D.S M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	64716	CA

General Provider Information

NPI Number	:	1467825786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JUNG KIM D.D.S M.D.

Provider Business Mailing Address
First Line	:	5119 MOLINO
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-4832
Country	:	US
Telephone Number	:	415-816-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4448 E VILLAGE RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1540
Country	:	US
Telephone Number	:	415-816-7749
Fax Number	:

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

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	07/28/2022

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