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NPI Code Detail

MEDICARE: DR. BRIAN S. KIM DMD

MEDICARE: DR. BRIAN S. 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 Dentistry54517CA

General Provider Information

NPI Number : 1841386422
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN S. KIM DMD
Provider Business Mailing Address
First Line : 175 W COURT ST
Second Line :
City : WOODLAND
State : CA
Zip : 95695-2913
Country : US
Telephone Number : 530-661-4430
Fax Number :
Provider Business Practice Location Address
First Line : 175 W COURT ST
Second Line :
City : WOODLAND
State : CA
Zip : 95695-2913
Country : US
Telephone Number : 530-661-4430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 11/03/2008

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