NPIMap

Organization Active NPI

Young Kim D.D.S. Inc.

Doing business as san pedro family dentist

  • General Practice Dentistry
  • San Pedro, CA
National Provider Identifier
1114174216
Registry record updated Aug 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
31939 Issued in CA
Legal business name
YOUNG KIM D.D.S. INC.
Doing business as
san pedro family dentist
Practice address
204 N Pacific Ave
San Pedro, CA 90731-2016
Phone
(310) 832-8800
Fax
(310) 832-8801
NPI assigned
Aug 20, 2008
Last updated
Aug 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Young Kim, D.D.S.
Title
Dentist/Owner
Phone
(310) 832-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 31939 CA Primary

Addresses

Primary practice location

204 N Pacific Ave
San Pedro, CA 90731-2016

Mailing address

204 North Pacific Ave
San Pedro, CA 90731
Phone (310) 832-8800

Other names 1

  • san pedro family dentist Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Young Kim DDS Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

204 N Pacific Ave
San Pedro, CA 90731
Phone (310) 832-0291

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219190400000",
    "number": "1114174216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 NORTH PACIFIC AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "90731",
            "telephone_number": "310-832-8800",
            "fax_number": "310-832-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 N PACIFIC AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312016",
            "telephone_number": "310-832-8800",
            "fax_number": "310-832-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUNG KIM D.D.S. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-08-20",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "YOUNG",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "310-832-8800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "31939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "san pedro family dentist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.