Provider Demographics
NPI:1437392339
Name:KIM, YOUNGGIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUNGGIL
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 1:3727 ANDREWS HWY
Mailing Address - Street 2:2102
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8603
Mailing Address - Country:US
Mailing Address - Phone:432-258-0259
Mailing Address - Fax:
Practice Address - Street 1:1613 N COUNTY RD W
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-2915
Practice Address - Country:US
Practice Address - Phone:432-614-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice