MEDICARE: CATHERINE KIM

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223E0200X	Endodontics	64637	CA

General Provider Information

NPI Number	:	1881072882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE KIM

Provider Business Mailing Address
First Line	:	28212 KELLY JOHNSON PKWY STE 290
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-5093
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28212 KELLY JOHNSON PKWY STE 290
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-5093
Country	:	US
Telephone Number	:	661-254-1924
Fax Number	:

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

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	01/29/2024

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Directions to “ CATHERINE KIM ” Practice Location

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