Provider Demographics
NPI:1992826333
Name:KIM, SANG YOON (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:YOON
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD, MD
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Mailing Address - Street 1:361 MAPLE AVE W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4304
Mailing Address - Country:US
Mailing Address - Phone:703-255-9400
Mailing Address - Fax:703-255-4958
Practice Address - Street 1:361 MAPLE AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4304
Practice Address - Country:US
Practice Address - Phone:703-255-9400
Practice Address - Fax:703-255-4958
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101251217204E00000X
VA04014134541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery