Provider Demographics
NPI:1043825771
Name:KIM, YOUNG JO (DDS)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:JO
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 1:6383 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1227
Mailing Address - Country:US
Mailing Address - Phone:323-562-1301
Mailing Address - Fax:
Practice Address - Street 1:14309 S ATLANTIC AVE STE 104
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-2562
Practice Address - Country:US
Practice Address - Phone:310-438-1205
Practice Address - Fax:310-438-2067
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist