Provider Demographics
NPI:1952638298
Name:YIM, GREGORY EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWIN
Last Name:YIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3550 EUREKA WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-243-3300
Mailing Address - Fax:530-246-9174
Practice Address - Street 1:3550 EUREKA WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-243-3300
Practice Address - Fax:530-246-9174
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics