Provider Demographics
NPI:1598028136
Name:YOUNG JOON KIM, DDS, INC
Entity Type:Organization
Organization Name:YOUNG JOON KIM, DDS, INC
Other - Org Name:SAN JOSE YOUNG DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-337-4700
Mailing Address - Street 1:14514 RAMONA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3361
Mailing Address - Country:US
Mailing Address - Phone:626-337-4700
Mailing Address - Fax:626-337-8133
Practice Address - Street 1:14514 RAMONA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3361
Practice Address - Country:US
Practice Address - Phone:626-337-4700
Practice Address - Fax:626-337-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57043261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental