Provider Demographics
NPI:1831312644
Name:KIM, YONG YUL (DDS)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:YUL
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 1:3100 W 8TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1978
Mailing Address - Country:US
Mailing Address - Phone:213-389-2211
Mailing Address - Fax:213-389-4778
Practice Address - Street 1:3100 W 8TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1978
Practice Address - Country:US
Practice Address - Phone:213-389-2211
Practice Address - Fax:213-389-4778
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB374341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice