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General NPI Number Information
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NPI Number | 1003388307
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Entity Type | Organization
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Legal Business Name | JAMES YOUNG KIM DENTAL CORP
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 74420 HIGHWAY 111 STE 1
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City | PALM DESERT
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State | CA
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Zip | 92260-4144
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Country | US
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Telephone | 760-779-5662
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Fax | 760-779-5683
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Provider Business Mailing Address
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Address Line | 74420 HIGHWAY 111 STE 1
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City | PALM DESERT
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State | CA
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Zip | 92260-4144
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Country | US
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Telephone | 760-779-5662
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JAMES YOUNG KIM
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Credential |
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Telephone | 760-779-5662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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