MEDICARE: YOUNG KIM, DDS, INC.

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	1223G0001X	General Practice Dentistry	31939	CA

General Provider Information

NPI Number	:	1376813857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG KIM, DDS, INC.

Provider Business Mailing Address
First Line	:	1721 W KATELLA AVE
Second Line	:	SUITE #A
City	:	ANAHEIM
State	:	CA
Zip	:	92804-6100
Country	:	US
Telephone Number	:	714-772-5656
Fax Number	:	714-772-4434

Provider Business Practice Location Address
First Line	:	1014 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2620
Country	:	US
Telephone Number	:	323-664-3400
Fax Number	:	323-664-3404

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. YOUNG KIM
Credential	:	D.D.S
Telephone Number	:	714-772-5656

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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