Healthcare Provider Details

I. General information

NPI: 1306736368
Provider Name (Legal Business Name): YOUNG KWANG KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 BATTLEGROUND AVE
GREENSBORO NC
27408-5422
US

IV. Provider business mailing address

205 VILLA WAY
YORKTOWN VA
23693-3235
US

V. Phone/Fax

Practice location:
  • Phone: 336-355-4554
  • Fax:
Mailing address:
  • Phone: 757-528-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number14666
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: