Provider Demographics
NPI:1548356108
Name:KIM, SCOTT YONG JIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:YONG JIN
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 1:4220 W 3RD ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3450
Mailing Address - Country:US
Mailing Address - Phone:213-387-5570
Mailing Address - Fax:213-387-9492
Practice Address - Street 1:4220 W 3RD ST
Practice Address - Street 2:SUITE #101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3450
Practice Address - Country:US
Practice Address - Phone:213-387-5570
Practice Address - Fax:213-387-9492
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice