MEDICARE: MEEYOUNG J. KIM D.D.S.

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	1223P0700X	Prosthodontics	49907	CA

General Provider Information

NPI Number	:	1710131115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEEYOUNG J. KIM D.D.S.

Provider Business Mailing Address
First Line	:	437 W COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1537
Country	:	US
Telephone Number	:	818-244-0299
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 W COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1537
Country	:	US
Telephone Number	:	818-244-0299
Fax Number	:

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	04/28/2017

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