Provider Demographics
NPI:1124567292
Name:KIM, YOOMIN AHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOOMIN
Middle Name:AHN
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36602 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1937
Mailing Address - Country:US
Mailing Address - Phone:586-727-5500
Mailing Address - Fax:
Practice Address - Street 1:36602 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1937
Practice Address - Country:US
Practice Address - Phone:586-727-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0606231223P0221X
390200000X
MI29016007841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program