Provider Demographics
NPI:1518008804
Name:KIM, SCOTT YUNG
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:YUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5310
Mailing Address - Country:US
Mailing Address - Phone:323-895-3007
Mailing Address - Fax:323-869-5427
Practice Address - Street 1:5427 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4101
Practice Address - Country:US
Practice Address - Phone:323-895-3007
Practice Address - Fax:323-869-5427
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103509207RI0200X
NY318268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease