MEDICARE: MARY ANN KIM, DDS., PC

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

General Provider Information

NPI Number	:	1598618050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY ANN KIM, DDS., PC

Provider Business Mailing Address
First Line	:	2101 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4528
Country	:	US
Telephone Number	:	773-227-8005
Fax Number	:	773-227-9115

Provider Business Practice Location Address
First Line	:	2101 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4528
Country	:	US
Telephone Number	:	773-227-8005
Fax Number	:	773-227-9115

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	DR. MARY ANN KIM
Credential	:	DDS
Telephone Number	:	773-227-8005

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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