Provider Demographics
NPI:1417176843
Name:KI, LAURA YOOMEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:YOOMEE
Last Name:KI
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 1:4001 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2917
Mailing Address - Country:US
Mailing Address - Phone:703-273-2545
Mailing Address - Fax:703-273-1116
Practice Address - Street 1:4001 FAIR RIDGE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:703-273-2545
Practice Address - Fax:703-273-1116
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA79061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice