Provider Demographics
NPI:1003388307
Name:JAMES YOUNG KIM DENTAL CORP
Entity Type:Organization
Organization Name:JAMES YOUNG KIM DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-779-5662
Mailing Address - Street 1:74420 HIGHWAY 111 STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4144
Mailing Address - Country:US
Mailing Address - Phone:760-779-5662
Mailing Address - Fax:
Practice Address - Street 1:74420 HIGHWAY 111 STE 1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4144
Practice Address - Country:US
Practice Address - Phone:760-779-5662
Practice Address - Fax:760-779-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty