Provider Demographics
NPI:1013461136
Name:Y KIM A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:Y KIM A PROFESSIONAL CORP
Other - Org Name:SOUTHWEST DENTAL & DENTURES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-897-5560
Mailing Address - Street 1:2538 ANTHEM VILLAGE DR
Mailing Address - Street 2:#100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5550
Mailing Address - Country:US
Mailing Address - Phone:702-897-5560
Mailing Address - Fax:
Practice Address - Street 1:2538 ANTHEM VILLAGE DR
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5550
Practice Address - Country:US
Practice Address - Phone:702-897-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty