Provider Demographics
NPI:1942699160
Name:KIM, YOUNGSAM I
Entity Type:Individual
Prefix:DR
First Name:YOUNGSAM
Middle Name:
Last Name:KIM
Suffix:I
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 1:4330 BARRANCA PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1703
Mailing Address - Country:US
Mailing Address - Phone:949-523-2875
Mailing Address - Fax:949-523-2876
Practice Address - Street 1:4330 BARRANCA PKWY STE 140
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1703
Practice Address - Country:US
Practice Address - Phone:949-523-2875
Practice Address - Fax:949-523-2876
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist