MEDICARE: S.S. KIM, D.D.S., INC.

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	39026	CA

General Provider Information

NPI Number	:	1477918811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S.S. KIM, D.D.S., INC.

Provider Business Mailing Address
First Line	:	9800 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1617
Country	:	US
Telephone Number	:	714-638-9370
Fax Number	:	714-534-5545

Provider Business Practice Location Address
First Line	:	9800 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1617
Country	:	US
Telephone Number	:	714-638-9370
Fax Number	:	714-534-5545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN SUNGKEE KIM
Credential	:	D.D.S.
Telephone Number	:	951-687-7300

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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