Provider Demographics
NPI:1629140199
Name:YOUNG, RICHARD KIM (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KIM
Last Name:YOUNG
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 1:122 S PATTERSON AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-4051
Mailing Address - Country:US
Mailing Address - Phone:805-967-5010
Mailing Address - Fax:805-683-3573
Practice Address - Street 1:122 S PATTERSON AVE STE 115
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-4051
Practice Address - Country:US
Practice Address - Phone:805-967-5010
Practice Address - Fax:805-683-3573
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice