Provider Demographics
NPI:1215264098
Name:KIM, YOUNG KWUN (DDS)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:KWUN
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 1:8110 MANGO AVE
Mailing Address - Street 2:101
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8110 MANGO AVE
Practice Address - Street 2:101
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3603
Practice Address - Country:US
Practice Address - Phone:909-829-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice