MEDICARE: DR. CHRISTINA P. 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	1223G0001X	General Practice Dentistry	5051	OK

General Provider Information

NPI Number	:	1497807820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA P. KIM DDS

Provider Business Mailing Address
First Line	:	2816 NW 58TH ST
Second Line	:	SUITE 101
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6899
Country	:	US
Telephone Number	:	405-848-4404
Fax Number	:	405-848-0654

Provider Business Practice Location Address
First Line	:	5920 N MAY AVENUE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112
Country	:	US
Telephone Number	:	405-494-4961
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	12/27/2021

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