Provider Demographics
NPI:1710076070
Name:KIM, JIYOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 ENCINITAS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4355
Mailing Address - Country:US
Mailing Address - Phone:760-753-9052
Mailing Address - Fax:760-753-9085
Practice Address - Street 1:2235 ENCINITAS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4355
Practice Address - Country:US
Practice Address - Phone:760-753-9052
Practice Address - Fax:760-753-9085
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436181223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics