Provider Demographics
NPI:1295069722
Name:KIM, YOON JAE (DMD)
Entity type:Individual
Prefix:DR
First Name:YOON
Middle Name:JAE
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BELMONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1952
Mailing Address - Country:US
Mailing Address - Phone:508-230-0048
Mailing Address - Fax:
Practice Address - Street 1:165 BELMONT ST STE A
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1952
Practice Address - Country:US
Practice Address - Phone:508-230-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH037491223G0001X
MADN18552951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice