MEDICARE: ANTHONY KIM DDS INC

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	48930	CA

General Provider Information

NPI Number	:	1992051460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY KIM DDS INC

Provider Business Mailing Address
First Line	:	7154 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3804
Country	:	US
Telephone Number	:	951-686-3666
Fax Number	:	951-686-3675

Provider Business Practice Location Address
First Line	:	7154 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3804
Country	:	US
Telephone Number	:	951-686-3666
Fax Number	:	951-686-3675

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY KIM
Credential	:	DDS
Telephone Number	:	951-686-3666

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/02/2012

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