Provider Demographics
NPI:1114174216
Name:YOUNG KIM D.D.S. INC.
Entity Type:Organization
Organization Name:YOUNG KIM D.D.S. INC.
Other - Org Name:SAN PEDRO FAMILY DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-832-8800
Mailing Address - Street 1:204 NORTH PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731
Mailing Address - Country:US
Mailing Address - Phone:310-832-8800
Mailing Address - Fax:310-832-8801
Practice Address - Street 1:204 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2016
Practice Address - Country:US
Practice Address - Phone:310-832-8800
Practice Address - Fax:310-832-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty