Provider Demographics
NPI:1972269512
Name:PREMIER ORAL SURGERY AND IMPLANTOLOGY PLLC
Entity Type:Organization
Organization Name:PREMIER ORAL SURGERY AND IMPLANTOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:CHI YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-784-4737
Mailing Address - Street 1:209 HARVARD ST STE 307
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5005
Mailing Address - Country:US
Mailing Address - Phone:617-468-5110
Mailing Address - Fax:617-468-5111
Practice Address - Street 1:209 HARVARD ST STE 307
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5005
Practice Address - Country:US
Practice Address - Phone:617-468-5110
Practice Address - Fax:617-468-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty