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NPI Code Detail

MEDICARE: KI W YOUN DDS INC

MEDICARE: KI W YOUN DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1124681036
Entity Type Code : Organization
Provider Name (Legal Business Name) : KI W YOUN DDS INC
Provider Business Mailing Address
First Line : 18250 COLIMA RD STE 201
Second Line :
City : ROWLAND HEIGHTS
State : CA
Zip : 91748-2618
Country : US
Telephone Number : 626-964-2875
Fax Number :
Provider Business Practice Location Address
First Line : 5301 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-6019
Country : US
Telephone Number : 626-964-2875
Fax Number :
Authorized Official
Title or Position : GENERAL DENTIST
Name : DR. KIWON YOUN
Credential :
Telephone Number : 626-964-2875
Provider Enumeration Date : 04/16/2019
Last Update Date : 04/16/2019

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Directions to “KI W YOUN DDS INC ” Practice Location

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