MEDICARE: KIMMER E. YOUNG D.D.S. DENTAL CORPORATION

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1306317755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMMER E. YOUNG D.D.S. DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2401 W CLEVELAND AVE
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-3608
Country	:	US
Telephone Number	:	559-970-6188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 W CLEVELAND AVE
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-3608
Country	:	US
Telephone Number	:	559-673-4075
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMMER E YOUNG
Credential	:
Telephone Number	:	559-673-4075

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	12/13/2018

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