MEDICARE: DR. SCOTT YONG JIN 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	39668	CA

General Provider Information

NPI Number	:	1548356108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT YONG JIN KIM DDS

Provider Business Mailing Address
First Line	:	4220 W 3RD ST
Second Line	:	SUITE #101
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3450
Country	:	US
Telephone Number	:	213-387-5570
Fax Number	:	213-387-9492

Provider Business Practice Location Address
First Line	:	4220 W 3RD ST
Second Line	:	SUITE #101
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-3450
Country	:	US
Telephone Number	:	213-387-5570
Fax Number	:	213-387-9492

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/11/2010

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