Provider Demographics
NPI:1295972115
Name:KIM, CELESTE HOIN (DMD)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:HOIN
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 VALLEY BROOK AVE FL 2A
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1995
Mailing Address - Country:US
Mailing Address - Phone:201-933-9092
Mailing Address - Fax:
Practice Address - Street 1:464 VALLEY BROOK AVE FL 2A
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1995
Practice Address - Country:US
Practice Address - Phone:201-933-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037622122300000X
NJDI025298001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist