MEDICARE: DR. STEPHANIE KIM-ALBADAWI D.M.D., M.S.D.

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	1223P0221X	Pediatric Dentistry	12014639A	IN
3	1223G0001X	General Practice Dentistry	64762	CA
4	1223P0221X	Pediatric Dentistry	64762	CA

General Provider Information

NPI Number	:	1942615364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE KIM-ALBADAWI D.M.D., M.S.D.

Provider Business Mailing Address
First Line	:	252 MERCEDES CT
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-0280
Country	:	US
Telephone Number	:	661-203-1353
Fax Number	:

Provider Business Practice Location Address
First Line	:	13760 LAKERIDGE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-7608
Country	:	US
Telephone Number	:	317-588-2575
Fax Number	:

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

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	01/22/2025

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