Provider Demographics
NPI:1073641098
Name:YI, JANG KIL (DDS)
Entity Type:Individual
Prefix:MR
First Name:JANG
Middle Name:KIL
Last Name:YI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 PACIFIC BL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2929
Mailing Address - Country:US
Mailing Address - Phone:323-581-0100
Mailing Address - Fax:323-581-2799
Practice Address - Street 1:5914 PACIFIC BL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2929
Practice Address - Country:US
Practice Address - Phone:323-581-0100
Practice Address - Fax:323-581-2799
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28641208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice