Provider Demographics
NPI:1376813857
Name:YOUNG KIM, DDS, INC.
Entity Type:Organization
Organization Name:YOUNG KIM, DDS, INC.
Other - Org Name:WELCOME DENTISTRY & BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
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:714-772-5656
Mailing Address - Street 1:1721 W KATELLA AVE
Mailing Address - Street 2:SUITE #A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6100
Mailing Address - Country:US
Mailing Address - Phone:714-772-5656
Mailing Address - Fax:714-772-4434
Practice Address - Street 1:1014 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2620
Practice Address - Country:US
Practice Address - Phone:323-664-3400
Practice Address - Fax:323-664-3404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG KIM, DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty