Provider Demographics
NPI:1386971000
Name:KIM, JULIE YONGSOOK (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:YONGSOOK
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 1:2882 MUIR TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5516
Mailing Address - Country:US
Mailing Address - Phone:562-505-6301
Mailing Address - Fax:
Practice Address - Street 1:7841 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2422
Practice Address - Country:US
Practice Address - Phone:714-739-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA580331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice