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General NPI Number Information
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NPI Number | 1861750051
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Entity Type | Organization
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Legal Business Name | KIM, YONG YUL D.D.S, A PROF DENTAL
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 3100 W 8TH ST 105
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City | LOS ANGELES
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State | CA
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Zip | 90005-1978
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Country | US
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Telephone | 213-389-2211
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Fax | 213-389-4778
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Provider Business Mailing Address
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Address Line | 3100 W 8TH ST 105
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City | LOS ANGELES
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State | CA
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Zip | 90005-1978
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Country | US
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Telephone | 213-389-2211
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Fax | 213-389-4778
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Authorized Official
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Title or Position | PRESIDENT
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Name | YONG YUL KIM
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Credential | D.D.S.
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Telephone | 213-389-2211
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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 | B37434
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License Number State | CA
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