MEDICARE: JOHN D KIM DMD

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	319.020174	IL
2	122300000X	Dentist	38650	TX

General Provider Information

NPI Number	:	1720531403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D KIM DMD

Provider Business Mailing Address
First Line	:	523 S FANNIN AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-8204
Country	:	US
Telephone Number	:	903-535-9041
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E 9TH ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-4227
Country	:	US
Telephone Number	:	903-991-4991
Fax Number	:

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

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	04/08/2023

Similar Medicare Providers

1962861138 — ERIK MALONE D.C.
Practice Location Address:

140 E 9TH ST
TYLER, TX
75701-4227

Practice Phone: 902-218-2238
Practice Fax:

1699619874 — GENEVIEVE JANAE BURTON
Practice Location Address:

6003 OLD BULLARD RD APT 117
TYLER, TX
75703-4227

Practice Phone: 430-205-8710
Practice Fax:

1346106440 — EMILY ANN BARNETT CSFA
Practice Location Address:

800 E DAWSON ST
TYLER, TX
75701-2036

Practice Phone: 903-593-8441
Practice Fax:

1851969299 — BRIAN RUIZ DO, MS
Practice Location Address:

700 S FLEISHEL AVE
TYLER, TX
75701-2014

Practice Phone: 903-606-5600
Practice Fax: 903-606-5605

1710131511 — ANDREW JACOB SKABELUND MD
Practice Location Address:

619 S FLEISHEL AVE STE 100
TYLER, TX
75701-2004

Practice Phone: 903-606-2299
Practice Fax: 903-606-2838

1265472880 — MS. AMY C SPROLES P.A.-C
Practice Location Address:

800 E DAWSON ST
TYLER, TX
75701-2036

Practice Phone: 903-593-8441
Practice Fax:

Directions to “ JOHN D KIM DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.