Provider Demographics
NPI:1912248832
Name:YOUNG R. KIM, DDS, INC
Entity Type:Organization
Organization Name:YOUNG R. KIM, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:YOUNGRYUT
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-522-3734
Mailing Address - Street 1:5300 BEACH BLVD.
Mailing Address - Street 2:#109
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1291
Mailing Address - Country:US
Mailing Address - Phone:714-522-3734
Mailing Address - Fax:714-522-1291
Practice Address - Street 1:5300 BEACH BLVD.
Practice Address - Street 2:#109
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1291
Practice Address - Country:US
Practice Address - Phone:714-522-3734
Practice Address - Fax:714-522-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty