Provider Demographics
NPI:1649332891
Name:KIM, GREG YOOKYONG (DDS)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:YOOKYONG
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 1:9690 W TROPICANA AVE
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-2601
Mailing Address - Country:US
Mailing Address - Phone:702-876-0000
Mailing Address - Fax:
Practice Address - Street 1:9690 W TROPICANA AVE
Practice Address - Street 2:#100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-2601
Practice Address - Country:US
Practice Address - Phone:702-876-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-80C1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics