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General NPI Number Information
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NPI Number | 1841892247
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Entity Type | Individual
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Provider Name | YOUNG DO KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 1101 E WALTON BLVD
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City | PONTIAC
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State | MI
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Zip | 48340-1591
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Country | US
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Telephone | 248-499-9989
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 STRAND AVE
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8205
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Country | US
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Telephone | 404-641-5993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2901600771
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License Number State | MI
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