Provider Demographics
NPI:1861750051
Name:KIM, YONG YUL D.D.S, A PROF DENTAL
Entity type:Organization
Organization Name:KIM, YONG YUL D.D.S, A PROF DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:YUL
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-389-2211
Mailing Address - Street 1:3100 W 8TH ST
Mailing Address - Street 2:105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1978
Mailing Address - Country:US
Mailing Address - Phone:213-389-2211
Mailing Address - Fax:213-389-4778
Practice Address - Street 1:3100 W 8TH ST
Practice Address - Street 2:105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1978
Practice Address - Country:US
Practice Address - Phone:213-389-2211
Practice Address - Fax:213-389-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB374341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty