MEDICARE: EUN BEE 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	7650	NV

General Provider Information

NPI Number	:	1720705700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUN BEE KIM DMD

Provider Business Mailing Address
First Line	:	5008 LOWER FALLS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-8638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6680 W FLAMINGO RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2189
Country	:	US
Telephone Number	:	702-389-0430
Fax Number	:

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

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	11/21/2022

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