MEDICARE: J.KIM DENTAL CONSULTANTS LTD.

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		IL

General Provider Information

NPI Number	:	1992977045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.KIM DENTAL CONSULTANTS LTD.

Provider Business Mailing Address
First Line	:	4044 N NARRAGANSETT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1586
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4044 N NARRAGANSETT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1586
Country	:	US
Telephone Number	:	773-545-4426
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JOHN KIM
Credential	:
Telephone Number	:	773-545-4426

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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