| Shanna K. Kim Dds, Pllc | |
|
4840 Vista Blvd Ste 108 Sparks NV 89436-2850 | |
| (775) 241-8489 | |
| Not Available |
| Full Name | Shanna K. Kim Dds, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 4840 Vista Blvd Ste 108, Sparks, Nevada |
| Authorized Official Name and Position | Shanna Kim (OWNER) |
| Authorized Official Contact | 7752418489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shanna K. Kim Dds, Pllc Po Box 17128 Reno NV 89511-3101 Ph: () - | Shanna K. Kim Dds, Pllc 4840 Vista Blvd Ste 108 Sparks NV 89436-2850 Ph: (775) 241-8489 |
| NPI Number | 1437976867 |
|---|---|
| Provider Enumeration Date | 09/25/2024 |
| Last Update Date | 09/25/2024 |
| Medicare PECOS PAC ID | 3173056363 |
|---|---|
| Medicare Enrollment ID | O20241025003294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437976867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X2210X | Dentist - Orofacial Pain | (* (Not Available)) | Primary |
| Provider Name | Shanna Kyungmi Kim |
|---|---|
| Provider Type | Practitioner - Orofacial Pain |
| Provider Identifiers | NPI Number: 1710282272 PECOS PAC ID: 9032370465 Enrollment ID: I20211122002238 |
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