MEDICARE: KYONG H KIM DDS LLC

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	1223G0001X	General Practice Dentistry	047812	NY
2	1223G0001X	General Practice Dentistry	39288	CA
3	1223G0001X	General Practice Dentistry	4145	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780738112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYONG H KIM DDS LLC

Provider Business Mailing Address
First Line	:	6941 NORTH TRENHOLM ROAD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-1715
Country	:	US
Telephone Number	:	803-743-9894
Fax Number	:	803-743-9896

Provider Business Practice Location Address
First Line	:	6941 NORTH TRENHOLM ROAD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-1715
Country	:	US
Telephone Number	:	803-743-9894
Fax Number	:	803-743-9896

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYONG H KIM
Credential	:	DDS
Telephone Number	:	803-528-3383

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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Directions to “KYONG H KIM DDS LLC ” Practice Location

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