| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JONATHAN KIM | 1083084404 | 2022-10-01 |
Jonathan Kim is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1083084404. Registration indicates Jonathan Kim is a provider of access to dentists-general services with a specialization in Dental Providers, Dentist (Dental Providers, Dentist) (Dentist, ) (Dental, ) (Dentist, Dental Providers) Access to Dentists-General (Dental Providers, Dentist) (Dental Providers, Dentist) (Dentist, ) (Dental, ) (Dentist, Dental Providers) Access to Dentists-General (Dental Providers, Dentist) (Dental Providers, Dentist) (Dentist, ) (Dental, ) (Dentist, Dental Providers)
| Registration | PART-B:Y DME:Y HHA:Y PMD:N |
| Entity Type | Individual |
| Provider Name | Dr. Jonathan Kim DDS |
| Practice Office Address | 1830 SCENIC HWY N STE 220 SNELLVILLE, GA US |
| Practice Office Telephone | 7708449454 |
| Mailing Address | 4323 TACOMA TRCE SUWANEE, GA 300248731 US |
| Business Telephone | 6783616213 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 27289 Willow Leaf Rd | Moreno Valley, CA 925554755 | 6783616213 |
| Code | Practice | License No State |
|---|---|---|
| 122300000X | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist Dental Dentist Dental Providers | 65136
CA |
| 122300000X | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist Dental Dentist Dental Providers | 60793892
WA |
| 122300000X PRIMARY | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist Dental Dentist Dental Providers | DN122806
GA |