Provider Demographics
NPI:1922618297
Name:KIM, YOUNGJOON LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNGJOON
Middle Name:LEE
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 LAKE APACHE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5811
Mailing Address - Country:US
Mailing Address - Phone:909-602-7007
Mailing Address - Fax:
Practice Address - Street 1:13032 NACOGDOCHES RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1962
Practice Address - Country:US
Practice Address - Phone:909-602-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice