Provider Demographics
NPI:1578899886
Name:YOCHIM, JI MIN (DMD)
Entity Type:Individual
Prefix:
First Name:JI MIN
Middle Name:
Last Name:YOCHIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 BAXTER LN UNIT 4708
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59772-8068
Mailing Address - Country:US
Mailing Address - Phone:909-353-4004
Mailing Address - Fax:
Practice Address - Street 1:120 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3304
Practice Address - Country:US
Practice Address - Phone:406-404-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13545332B00000X, 1223P0221X
CA588111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies