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NPI Code Detail

MEDICARE: ANNE KIM DDS

MEDICARE: ANNE 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
11223G0001XGeneral Practice DentistryDDS102900CA

General Provider Information

NPI Number : 1619450715
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNE KIM DDS
Provider Business Mailing Address
First Line : 1711 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-2018
Country : US
Telephone Number : 562-591-4028
Fax Number : 562-591-5878
Provider Business Practice Location Address
First Line : 1711 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-2018
Country : US
Telephone Number : 562-591-4028
Fax Number : 562-591-5878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2018
Last Update Date : 09/13/2018

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