MEDICARE: HYOUNG KEUN KIM DMD

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	122300000X	Dentist	15967	MD

General Provider Information

NPI Number	:	1942676952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYOUNG KEUN KIM DMD

Provider Business Mailing Address
First Line	:	14311 ROSETREE CT
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-1938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10033 BALTIMORE PIKE SUITE 320
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042
Country	:	US
Telephone Number	:	240-731-5876
Fax Number	:

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

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/13/2015

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