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General NPI Number Information
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NPI Number | 1376813857
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Entity Type | Organization
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Legal Business Name | YOUNG KIM, DDS, INC.
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 1014 N VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-2620
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Country | US
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Telephone | 323-664-3400
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Fax | 323-664-3404
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Provider Business Mailing Address
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Address Line | 1721 W KATELLA AVE SUITE #A
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City | ANAHEIM
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State | CA
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Zip | 92804-6100
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Country | US
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Telephone | 714-772-5656
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Fax | 714-772-4434
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Authorized Official
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Title or Position | DENTIST
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Name | DR. YOUNG KIM
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Credential | D.D.S
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Telephone | 714-772-5656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31939
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License Number State | CA
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