Provider Demographics
NPI:1114135076
Name:KIM, MELANIE YONMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:YONMI
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 RIVER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2237
Mailing Address - Country:US
Mailing Address - Phone:201-699-0565
Mailing Address - Fax:
Practice Address - Street 1:968 RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2237
Practice Address - Country:US
Practice Address - Phone:201-699-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0492481223E0200X
NJ22DI021685001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics