1992059836 NPI number — YOUNG KIM, DDS, INC.

Table of content: SINAI REY CONSUEGRA DMD (NPI 1538680129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992059836 NPI number — YOUNG KIM, DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUNG KIM, DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WELCOME DENTISTRY & BRACES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992059836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16388 COLIMA ROAD
Provider Second Line Business Mailing Address:
SUITE #201
Provider Business Mailing Address City Name:
HACIENDA HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-333-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16388 COLIMA ROAD
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
HACIENDA HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-333-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
YOUNG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
714-772-5656

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  31939 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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