Healthcare Provider Details

I. General information

NPI: 1427717701
Provider Name (Legal Business Name): YEJIN KIM DDS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5316 S VERMONT AVE
LOS ANGELES CA
90037-3530
US

IV. Provider business mailing address

5316 S VERMONT AVE
LOS ANGELES CA
90037-3530
US

V. Phone/Fax

Practice location:
  • Phone: 619-346-0190
  • Fax:
Mailing address:
  • Phone: 619-346-0190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YEJIN KIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 619-346-0190