Provider Demographics
NPI:1407019417
Name:ASHLEY Y. KI DENTAL PC
Entity Type:Organization
Organization Name:ASHLEY Y. KI DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:YONSOOK
Authorized Official - Last Name:KI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-321-7181
Mailing Address - Street 1:16410 NORTHERN BLVD
Mailing Address - Street 2:SUITE #214
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2668
Mailing Address - Country:US
Mailing Address - Phone:718-321-7181
Mailing Address - Fax:718-321-7197
Practice Address - Street 1:16410 NORTHERN BLVD
Practice Address - Street 2:SUITE #214
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2668
Practice Address - Country:US
Practice Address - Phone:718-321-7181
Practice Address - Fax:718-321-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0487541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02543180Medicaid