MEDICARE: HYUNA KIM D.M.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	122300000X	Dentist	019028671	IL
2	122300000X	Dentist	DS038733	PA
3	122300000X	Dentist	DN19680	FL

General Provider Information

NPI Number	:	1962798785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUNA KIM D.M.D

Provider Business Mailing Address
First Line	:	1800 S OCEAN DR APT 1909
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-7725
Country	:	US
Telephone Number	:	352-246-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2747 E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4941
Country	:	US
Telephone Number	:	954-781-4670
Fax Number	:

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	04/23/2014

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