Provider Demographics
NPI:1437384203
Name:KIM, JAMES YONG (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:YONG
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 1:930 MILMADA DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2522
Mailing Address - Country:US
Mailing Address - Phone:818-621-5359
Mailing Address - Fax:
Practice Address - Street 1:7901 W TROPICAL PKWY STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4550
Practice Address - Country:US
Practice Address - Phone:702-839-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0581141223S0112X
CADDS1098251223S0112X
NVS2-149C1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery