Provider Demographics
NPI:1497919229
Name:KIM, YONG-HA (DDS)
Entity Type:Individual
Prefix:DR
First Name:YONG-HA
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 E WASHINGTON ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3338
Mailing Address - Country:US
Mailing Address - Phone:330-722-4506
Mailing Address - Fax:
Practice Address - Street 1:807 E WASHINGTON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3338
Practice Address - Country:US
Practice Address - Phone:330-722-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 0228271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice