Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 10929 | AZ |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 62347 | AZ |
NPI | 1457356057 |
---|---|
Provider Name | Dr. Alexander Youngwhan Kim |
First Address | Phoenix, AZ 85016-4879 |
Second Address | Phoenix, AZ 85016-4879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 14/08/2021 |