MEDICARE: DR. CHRISTOPHER KIM, DDS, PA

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	261QD0000X	Dental Clinic/Center	21561	TX

General Provider Information

NPI Number	:	1952748295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER KIM, DDS, PA

Provider Business Mailing Address
First Line	:	1609 OVERLOOK TER
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76262-9321
Country	:	US
Telephone Number	:	817-750-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	8455 BOAT CLUB RD
Second Line	:	SUITE 175
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3632
Country	:	US
Telephone Number	:	817-750-5433
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHRISTOPHER CHAEHO KIM
Credential	:	DDS
Telephone Number	:	817-750-5433

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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