Healthcare Provider Details

I. General information

NPI: 1467817767
Provider Name (Legal Business Name): Y. C. KIM DENTAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 NEW YORK RANCH RD SUITE 1
JACKSON CA
95642-9386
US

IV. Provider business mailing address

1465 LIVE OAK BLVD
YUBA CITY CA
95991-2920
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-3992
  • Fax:
Mailing address:
  • Phone: 530-673-1401
  • Fax: 530-673-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number50621
License Number StateCA

VIII. Authorized Official

Name: YONG KIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 702-419-6906