Provider Demographics
NPI:1720239866
Name:KIM, SOYOUNG L (DDS)
Entity Type:Individual
Prefix:
First Name:SOYOUNG
Middle Name:L
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CAHUILLA ST
Mailing Address - Street 2:SUIT 82
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4718
Mailing Address - Country:US
Mailing Address - Phone:909-210-7944
Mailing Address - Fax:
Practice Address - Street 1:2255 CAHUILLA ST
Practice Address - Street 2:SUIT 82
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4718
Practice Address - Country:US
Practice Address - Phone:909-210-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice