Healthcare Provider Details

I. General information

NPI: 1487578829
Provider Name (Legal Business Name): YUN YOUNG KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BELLA KIM

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC, CMR 402
APO AE
09180
US

IV. Provider business mailing address

6012 BIG SKY DR
FAIRFIELD CA
94533-7261
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-8326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: