Provider Demographics
NPI:1710044771
Name:KIM, JAMES YOUNG (DDS INC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15890 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1601
Mailing Address - Country:US
Mailing Address - Phone:626-333-0111
Mailing Address - Fax:626-333-2400
Practice Address - Street 1:15890 GALE AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1601
Practice Address - Country:US
Practice Address - Phone:626-333-0111
Practice Address - Fax:626-333-2400
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26-3123994OtherINTERNAL REVENUE SERVICE