Provider Demographics
NPI:1992079693
Name:YOUNG KIM DENTAL GROUP OF WESTMORELAND INC
Entity type:Organization
Organization Name:YOUNG KIM DENTAL GROUP OF WESTMORELAND INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-772-5656
Mailing Address - Street 1:900 S. WESTMORELAND AVE
Mailing Address - Street 2:SUITE #206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-352-1166
Mailing Address - Fax:714-772-4434
Practice Address - Street 1:900 S. WESTMORELAND AVE
Practice Address - Street 2:SUITE #206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-352-1166
Practice Address - Fax:714-772-4434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG KIM, DDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty