Provider Demographics
NPI:1194821827
Name:KIM, ELAINE DOYOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:DOYOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:DOYOUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4950 BARRANCA PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-252-9988
Mailing Address - Fax:
Practice Address - Street 1:4950 BARRANCA PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:949-252-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510221223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice