Provider Demographics
NPI:1184871840
Name:KIM, YOUNG K (DDS)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:K
Last Name:KIM
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 1:5511 CITY PL
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-3172
Mailing Address - Country:US
Mailing Address - Phone:201-403-0636
Mailing Address - Fax:
Practice Address - Street 1:6 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2431
Practice Address - Country:US
Practice Address - Phone:201-655-8575
Practice Address - Fax:201-944-1835
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022018021223G0001X
NJ22DI022018001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice