| Young Rae Kim Dental Corp | |
|
937 N Lemon St Anaheim CA 92805-1825 | |
| (714) 776-1202 | |
| (714) 776-9504 |
| Full Name | Young Rae Kim Dental Corp |
|---|---|
| Speciality | Dentist |
| Location | 937 N Lemon St, Anaheim, California |
| Authorized Official Name and Position | Young Rae Kim (CEO) |
| Authorized Official Contact | 7147761202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Young Rae Kim Dental Corp 937 N Lemon St Anaheim CA 92805-1825 Ph: (714) 776-1202 | Young Rae Kim Dental Corp 937 N Lemon St Anaheim CA 92805-1825 Ph: (714) 776-1202 |
| NPI Number | 1093123770 |
|---|---|
| Provider Enumeration Date | 07/25/2014 |
| Last Update Date | 07/25/2014 |
| Medicare PECOS PAC ID | 9830469337 |
|---|---|
| Medicare Enrollment ID | O20170717000876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093123770 | NPI | - | NPPES |
| 1205137999 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 59862 (California) | Primary |
| Provider Name | Young Rae Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1205137999 PECOS PAC ID: 0749550242 Enrollment ID: I20170717001052 |
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