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General NPI Number Information
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NPI Number | 1922296623
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Entity Type | Individual
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Provider Name | JIN YOUNG KIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 20657 GOLDEN SPRINGS DR. STE. 205B
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City | DIAMOND BAR
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State | CA
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Zip | 91789-3837
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Country | US
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Telephone | 909-859-8800
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Fax | 909-859-8753
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Provider Business Mailing Address
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Address Line | 20657 GOLDEN SPRINGS DR. STE. 205B
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City | DIAMOND BAR
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State | CA
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Zip | 91789-3837
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Country | US
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Telephone | 909-859-8800
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Fax | 909-859-8753
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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 | 54575
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 54575
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License Number State | CA
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