MEDICARE: DOOYEOL 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	40263	TX

General Provider Information

NPI Number	:	1891537874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOOYEOL KIM

Provider Business Mailing Address
First Line	:	7700 SAN FELIPE ST STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 SAN FELIPE ST STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1634
Country	:	US
Telephone Number	:	713-781-5548
Fax Number	:

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

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/12/2025

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Directions to “ DOOYEOL KIM ” Practice Location

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