Provider Demographics
NPI:1760039903
Name:KOH, YEI RIM (DDS)
Entity Type:Individual
Prefix:
First Name:YEI RIM
Middle Name:
Last Name:KOH
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 1:14125 NORTHERN BLVD APT D25
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4207
Mailing Address - Country:US
Mailing Address - Phone:646-915-2760
Mailing Address - Fax:
Practice Address - Street 1:2459 ARAMINGO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3731
Practice Address - Country:US
Practice Address - Phone:215-427-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0424331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice