MEDICARE: GO EUN KIM DMD, 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	122300000X	Dentist	103251	CA

General Provider Information

NPI Number	:	1518340009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GO EUN KIM DMD, MS

Provider Business Mailing Address
First Line	:	9225 SIERRA COLLEGE BLVD
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-5934
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 SIERRA COLLEGE BLVD
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-5934
Country	:	US
Telephone Number	:	916-367-4680
Fax Number	:

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

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	02/21/2026

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