Provider Demographics
NPI:1659575769
Name:KIM, YOOSEUNG (DDS)
Entity Type:Individual
Prefix:
First Name:YOOSEUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:YOOSEUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:118 SOUTH STANFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373
Mailing Address - Country:US
Mailing Address - Phone:937-335-3400
Mailing Address - Fax:937-335-3401
Practice Address - Street 1:118 SOUTH STANFIELD ROAD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373
Practice Address - Country:US
Practice Address - Phone:937-335-3400
Practice Address - Fax:937-335-3401
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T47880Medicare UPIN
OHKI0535801Medicare ID - Type Unspecified