Provider Demographics
NPI:1366013138
Name:KIM, YEONGBOK (DDS)
Entity Type:Individual
Prefix:
First Name:YEONGBOK
Middle Name:
Last Name:KIM
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 1:6372 TIVOLI LN
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-7329
Mailing Address - Country:US
Mailing Address - Phone:949-933-6372
Mailing Address - Fax:
Practice Address - Street 1:5405 ALTON PKWY STE F
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3719
Practice Address - Country:US
Practice Address - Phone:949-262-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist