Provider Demographics
NPI:1215385109
Name:KYE, WON YOUNG (DMD)
Entity Type:Individual
Prefix:
First Name:WON YOUNG
Middle Name:
Last Name:KYE
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 1:1661 WASHINGTON ST
Mailing Address - Street 2:APT505
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3331
Mailing Address - Country:US
Mailing Address - Phone:617-913-0919
Mailing Address - Fax:
Practice Address - Street 1:255 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1330
Practice Address - Country:US
Practice Address - Phone:508-583-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice