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NPI Code Detail

MEDICARE: JI IN KIM, D.D.S., PROFESSIONAL CORPORATION

MEDICARE: JI IN KIM, D.D.S., PROFESSIONAL CORPORATION
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
2124Q00000XDental Hygienist
31223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1881439016
Entity Type Code : Organization
Provider Name (Legal Business Name) : JI IN KIM, D.D.S., PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : 150 E CENTENNIAL PKWY STE 113
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-1338
Country : US
Telephone Number : 702-642-1386
Fax Number : 702-642-6321
Provider Business Practice Location Address
First Line : 150 E CENTENNIAL PKWY STE 113
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-1338
Country : US
Telephone Number : 702-642-1386
Fax Number : 702-642-6321
Authorized Official
Title or Position : OWNER
Name : DR. JI IN KIM
Credential : DDS
Telephone Number : 702-642-1386
Provider Enumeration Date : 06/28/2024
Last Update Date : 06/28/2024

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