Provider Demographics
NPI:1386790715
Name:KIM, YOUNGRIM (DDS)
Entity type:Individual
Prefix:
First Name:YOUNGRIM
Middle Name:
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 1:1137 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3614
Mailing Address - Country:US
Mailing Address - Phone:831-753-9505
Mailing Address - Fax:831-424-3699
Practice Address - Street 1:1137 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3614
Practice Address - Country:US
Practice Address - Phone:831-753-9505
Practice Address - Fax:831-424-3699
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice