Provider Demographics
NPI:1184750119
Name:YOUNG KIM, DDS, INC.
Entity type:Organization
Organization Name:YOUNG KIM, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-772-5656
Mailing Address - Street 1:570 W. 19TH ST.
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2749
Mailing Address - Country:US
Mailing Address - Phone:949-642-4222
Mailing Address - Fax:949-642-4855
Practice Address - Street 1:570 W. 19TH ST.
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2749
Practice Address - Country:US
Practice Address - Phone:949-642-4222
Practice Address - Fax:949-642-4855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG KIM D.D.S
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty