MEDICARE: DR. MINAH 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	048937	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932162377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINAH KIM DDS

Provider Business Mailing Address
First Line	:	228 W FIRST ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-1335
Country	:	US
Telephone Number	:	732-882-1697
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 BAY ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2510
Country	:	US
Telephone Number	:	718-226-3200
Fax Number	:

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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