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NPI Code Detail

MEDICARE: DR. DUSTIN KIM DMD

MEDICARE: DR. DUSTIN 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
11223G0001XGeneral Practice Dentistry2014024597MO
2122300000XDentist64398CA

General Provider Information

NPI Number : 1780093203
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUSTIN KIM DMD
Provider Business Mailing Address
First Line : 4900 CALIFORNIA AVE STE 400B
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-7081
Country : US
Telephone Number : 661-459-7049
Fax Number :
Provider Business Practice Location Address
First Line : 4900 CALIFORNIA AVE STE 400B
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-7081
Country : US
Telephone Number : 661-459-7049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2014
Last Update Date : 05/27/2016

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