Provider Demographics
NPI:1417110669
Name:KIM-BUNDY, YOUNGSUN ALICE (DMD)
Entity type:Individual
Prefix:MS
First Name:YOUNGSUN
Middle Name:ALICE
Last Name:KIM-BUNDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3835
Mailing Address - Country:US
Mailing Address - Phone:203-506-7479
Mailing Address - Fax:
Practice Address - Street 1:1525 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3835
Practice Address - Country:US
Practice Address - Phone:203-506-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222111223P0221X
CA594081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry