Provider Demographics
NPI:1073967543
Name:AH YOUNG KIM DMD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AH YOUNG KIM DMD A PROFESSIONAL CORPORATION
Other - Org Name:ADVANCED DENTURE AND IMPLANT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AH YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-470-4406
Mailing Address - Street 1:255 N SIERRA ST UNIT 515
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1378
Mailing Address - Country:US
Mailing Address - Phone:617-470-4406
Mailing Address - Fax:
Practice Address - Street 1:7520 LONGLEY LN STE 104
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-9811
Practice Address - Country:US
Practice Address - Phone:617-470-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5935261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental