MEDICARE: YOUNGCHAN KIM DDS

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	1223G0001X	General Practice Dentistry	110680	CA

General Provider Information

NPI Number	:	1922833888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNGCHAN KIM DDS

Provider Business Mailing Address
First Line	:	PO BOX 10059
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93389-0059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3790 N BLACKSTONE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-5306
Country	:	US
Telephone Number	:	559-225-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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Directions to “ YOUNGCHAN KIM DDS” Practice Location

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