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General NPI Number Information
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NPI Number | 1962685461
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Entity Type | Individual
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Provider Name | BEN YONG-IL KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 2500 ALHAMBRA AVE
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City | MARTINEZ
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State | CA
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Zip | 94553-3156
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Country | US
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Telephone | 925-788-5081
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Fax | 925-431-2506
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Provider Business Mailing Address
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Address Line | 14 VILLAGE SQUARE PL
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City | PLEASANT HILL
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State | CA
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Zip | 94523-4388
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Country | US
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Telephone | 925-788-5081
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0491210
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License Number State | CA
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