Jim J Im, D.D.S.
Individual provider Active NPI Dentist · Andrews Afb, MD
NPI 1023090347 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1023090347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 13490 (MD)
- Practice address
- 79TH DS
BLDG 1601
Andrews Afb, MD 20762 - Phone
- (240) 857-5029
- NPI assigned
- Nov 14, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13490 | MD | Yes |
Addresses
Primary practice location
79TH DS
BLDG 1601
Andrews Afb, MD 20762
Mailing address
9320 Van Guard CT
Owings Mills, MD 21117-8291
Phone (714) 833-0536
Other providers in Andrews Afb, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.