| James Young Kim Dental Corp | |
|
74420 Highway 111 Ste 1 Palm Desert CA 92260-4144 | |
| (760) 779-5662 | |
| (760) 779-5683 |
| Full Name | James Young Kim Dental Corp |
|---|---|
| Speciality | Dentist |
| Location | 74420 Highway 111 Ste 1, Palm Desert, California |
| Authorized Official Name and Position | James Young Kim (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7607795662 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James Young Kim Dental Corp 74420 Highway 111 Ste 1 Palm Desert CA 92260-4144 Ph: (760) 779-5662 | James Young Kim Dental Corp 74420 Highway 111 Ste 1 Palm Desert CA 92260-4144 Ph: (760) 779-5662 |
| NPI Number | 1003388307 |
|---|---|
| Provider Enumeration Date | 12/26/2018 |
| Last Update Date | 08/11/2022 |
| Medicare PECOS PAC ID | 3577953421 |
|---|---|
| Medicare Enrollment ID | O20211208000776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003388307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | James Y Kim |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1710044771 PECOS PAC ID: 6204143845 Enrollment ID: I20160831001504 |
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