MEDICARE: MI YOUNG KIM D.M.D

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	6208	AL
2	122300000X	Dentist	30.026633	OH

General Provider Information

NPI Number	:	1770965667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MI YOUNG KIM D.M.D

Provider Business Mailing Address
First Line	:	2830 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1785
Country	:	US
Telephone Number	:	513-585-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 PIEDMONT AVE STE 7300
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-4224
Country	:	US
Telephone Number	:	513-475-8783
Fax Number	:	513-475-8721

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

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	11/09/2021

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