Provider Demographics
NPI:1811136542
Name:KIM, YOUNG HO (DDS)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:YOUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:501 W OGDEN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3179
Mailing Address - Country:US
Mailing Address - Phone:630-323-2345
Mailing Address - Fax:630-323-2378
Practice Address - Street 1:501 W OGDEN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3179
Practice Address - Country:US
Practice Address - Phone:630-323-2345
Practice Address - Fax:630-323-2378
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist