MEDICARE: HAN NA 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	1223G0001X	General Practice Dentistry	107695	CA

General Provider Information

NPI Number	:	1790412757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN NA KIM DDS

Provider Business Mailing Address
First Line	:	1231 22ND AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1601
Country	:	US
Telephone Number	:	408-315-6064
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 SUTTER ST RM 2640
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4211
Country	:	US
Telephone Number	:	415-477-3700
Fax Number	:

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

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	08/01/2022

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