MEDICARE: HONG KU KIM, DDS, A PROFESSIONAL COOPERATION

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

General Provider Information

NPI Number	:	1992375901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONG KU KIM, DDS, A PROFESSIONAL COOPERATION

Provider Business Mailing Address
First Line	:	2379 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-4263
Country	:	US
Telephone Number	:	626-584-7017
Fax Number	:	626-584-7017

Provider Business Practice Location Address
First Line	:	2379 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-4263
Country	:	US
Telephone Number	:	626-584-7017
Fax Number	:	626-584-7017

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. HONG KU KIM
Credential	:	DDS
Telephone Number	:	626-584-7017

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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