MEDICARE: DR. CURTIS 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
1	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	1223G0001X	General Practice Dentistry	107505	CA

General Provider Information

NPI Number	:	1760065288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CURTIS KIM DDS

Provider Business Mailing Address
First Line	:	5801 MAYMONT LN
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-7301
Country	:	US
Telephone Number	:	925-989-6890
Fax Number	:

Provider Business Practice Location Address
First Line	:	4375 FIRST ST
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94551-4912
Country	:	US
Telephone Number	:	925-294-9288
Fax Number	:

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

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	08/03/2022

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