Provider Demographics
NPI:1225044860
Name:KIM, MIN YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:MIN
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12860 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4294
Mailing Address - Country:US
Mailing Address - Phone:909-591-0291
Mailing Address - Fax:909-591-5254
Practice Address - Street 1:12860 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4294
Practice Address - Country:US
Practice Address - Phone:909-591-0291
Practice Address - Fax:909-591-5254
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist