Provider Demographics
NPI:1619021631
Name:KIM-AUN, JI YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JI
Middle Name:YOUNG
Last Name:KIM-AUN
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 1:2607 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4700
Mailing Address - Country:US
Mailing Address - Phone:253-564-2701
Mailing Address - Fax:253-566-3638
Practice Address - Street 1:2607 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 1K
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4700
Practice Address - Country:US
Practice Address - Phone:253-564-2701
Practice Address - Fax:253-566-3638
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE96091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice