Provider Demographics
NPI:1023088408
Name:KIM, YOOSON E (DMD)
Entity type:Individual
Prefix:DR
First Name:YOOSON
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:FAMILY DENTISTRY - DR. YOOSON KIM
Mailing Address - Street 2:3411 MAIN STREET
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543
Mailing Address - Country:US
Mailing Address - Phone:610-286-0312
Mailing Address - Fax:
Practice Address - Street 1:FAMILY DENTISTRY - DR. YOOSON KIM
Practice Address - Street 2:3411 MAIN STREET
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543
Practice Address - Country:US
Practice Address - Phone:610-286-0312
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0311371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice