Provider Demographics
NPI:1619353935
Name:YANG, KYUNGSIK JAMES
Entity Type:Individual
Prefix:
First Name:KYUNGSIK
Middle Name:JAMES
Last Name:YANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 AVENUE AT PORT IMPERIAL APT 840
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6301
Mailing Address - Country:US
Mailing Address - Phone:201-983-1133
Mailing Address - Fax:
Practice Address - Street 1:121 E 60TH ST APT 11A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1198
Practice Address - Country:US
Practice Address - Phone:212-755-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058568-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty