Provider Demographics
NPI:1356865745
Name:KIM, VIVIAN JIYOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:JIYOUNG
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 1:67 LAKEVIEW AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605
Mailing Address - Country:US
Mailing Address - Phone:703-463-0043
Mailing Address - Fax:
Practice Address - Street 1:32 CLINTON ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522
Practice Address - Country:US
Practice Address - Phone:973-790-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026851001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice