| Doctor Name: | KELLY YEON SU KIM |
| NPI Number: | 1053625715 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.D.S |
| License Number: | 055114 |
| Business Practice Address: | 30001 Crown Valley Pkwy Suite G Laguna Niguel, CA - 926771723 |
| Business Phone Number: | 9494954245 |
| Business Fax Number: | |
| Mailing Address: | 30001 Crown Valley Pkwy, Suite G LAGUNA NIGUEL |
| State: | CA |
| Postal Code: | 926771723 |
| Phone Number: | 9494954245 |
| Fax Number: | |
| NPI Enumeration Date: | 08/04/2010 |
| NPI Last Update Date: | 06/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 055114 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |