Provider Demographics
NPI:1093284929
Name:KIM, YOUNG KYU (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:KYU
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N BRYAN BELT LINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2541
Mailing Address - Country:US
Mailing Address - Phone:972-288-3200
Mailing Address - Fax:972-288-3206
Practice Address - Street 1:2771 E BROAD ST STE 221
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9157
Practice Address - Country:US
Practice Address - Phone:817-473-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355771223G0001X
KY102081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice