Provider Demographics
NPI:1316145659
Name:KIM, JEAN YOUNG-YUM (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:YOUNG-YUM
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 1:5085 CAMPION DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5228
Mailing Address - Country:US
Mailing Address - Phone:925-648-2829
Mailing Address - Fax:
Practice Address - Street 1:401 GREGORY LN
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2800
Practice Address - Country:US
Practice Address - Phone:925-689-1020
Practice Address - Fax:925-689-1028
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist