Yong Soo Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7113006-9921 Issued in UT

Practice address

171 Inner Loop Rd
Fort Irwin, CA 92310

Phone

(760) 380-3166

NPI assigned

Oct 22, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1265684161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SHUTTLEWORTH DENTAL CLINIC",
            "address_2": "171 INNER LOOP RD.",
            "city": "FORT IRWIN",
            "state": "CA",
            "postal_code": "923105080",
            "telephone_number": "760-380-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 INNER LOOP RD",
            "city": "FORT IRWIN",
            "state": "CA",
            "postal_code": "92310",
            "telephone_number": "760-380-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "YONG",
        "middle_name": "SOO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-22",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7113006",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7113006-8903",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7113006-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Henry Lardizabal Kiley, R.N.
• Hye H Kim, DDS
• Ji Kim
• Kihyun Kim, D.O.
• Sung Soo Kim, DDS
• Todd Shuji Kimura, DDS
• Barbara Jeannette King, RN
• Brittany M Kirch, DO
• Kathyrn Elisabeth Klawitter, R.N.
• Youngkwang Ko

• General Practice Dentistry in Fort Irwin, CA
• Providers in Fort Irwin, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.