Provider Demographics
NPI:1588705891
Name:KIM, YUSEOK (DDS)
Entity type:Individual
Prefix:MR
First Name:YUSEOK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 NILES STREET
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4806
Mailing Address - Country:US
Mailing Address - Phone:661-326-0766
Mailing Address - Fax:661-326-6482
Practice Address - Street 1:1518 NILES STREET
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4806
Practice Address - Country:US
Practice Address - Phone:661-326-0766
Practice Address - Fax:661-326-6482
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA510891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9361701OtherDENTI CAL