MEDICARE: DR. JOHN KIM DDS, 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	44411	CA

General Provider Information

NPI Number	:	1629257712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KIM DDS, MS

Provider Business Mailing Address
First Line	:	18611 YORBA LINDA BLVD
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4136
Country	:	US
Telephone Number	:	714-777-1890
Fax Number	:

Provider Business Practice Location Address
First Line	:	18611 YORBA LINDA BLVD
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4136
Country	:	US
Telephone Number	:	714-777-1890
Fax Number	:

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	06/05/2009

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