| Third Avenue Bronx Dental Pc | |
|
2740 3rd Ave Bronx NY 10455-4036 | |
| (718) 618-0162 | |
| (718) 618-0173 |
| Full Name | Third Avenue Bronx Dental Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2740 3rd Ave, Bronx, New York |
| Authorized Official Name and Position | Sung Kwang Kim (OWNER) |
| Authorized Official Contact | 7186180162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Third Avenue Bronx Dental Pc 2740 3rd Ave Bronx NY 10455-4036 Ph: (718) 618-0162 | Third Avenue Bronx Dental Pc 2740 3rd Ave Bronx NY 10455-4036 Ph: (718) 618-0162 |
| NPI Number | 1720542210 |
|---|---|
| Provider Enumeration Date | 01/29/2019 |
| Last Update Date | 01/29/2019 |
| Medicare PECOS PAC ID | 3678998325 |
|---|---|
| Medicare Enrollment ID | O20200729001076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720542210 | NPI | - | NPPES |
| 05315619 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Sung Kwang Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1699108563 PECOS PAC ID: 1153629696 Enrollment ID: I20200729001227 |
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