Provider Demographics
NPI:1225175946
Name:KIM, YOUNG JIN (DMD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:JIN
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-1934
Mailing Address - Country:US
Mailing Address - Phone:856-365-6238
Mailing Address - Fax:856-365-6238
Practice Address - Street 1:2510 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-1934
Practice Address - Country:US
Practice Address - Phone:856-365-6238
Practice Address - Fax:856-365-6238
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist