Provider Demographics
NPI:1962664862
Name:KIM, YOUNGBAE (DDS)
Entity Type:Individual
Prefix:MR
First Name:YOUNGBAE
Middle Name:
Last Name:KIM
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 1:903 SOUTH CRENSHAW BLVD
Mailing Address - Street 2:#303
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90019
Mailing Address - Country:US
Mailing Address - Phone:323-930-4800
Mailing Address - Fax:323-930-4801
Practice Address - Street 1:903 CRENSHAW BLVD
Practice Address - Street 2:#303
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1964
Practice Address - Country:US
Practice Address - Phone:323-930-4800
Practice Address - Fax:323-930-4801
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice