Provider Demographics
NPI:1649813163
Name:KIL, KI YOUN (DDS)
Entity type:Individual
Prefix:
First Name:KI YOUN
Middle Name:
Last Name:KIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CONVENT AVE APT 46
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6352
Mailing Address - Country:US
Mailing Address - Phone:917-460-6661
Mailing Address - Fax:
Practice Address - Street 1:800 W BROAD ST STE 307
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3145
Practice Address - Country:US
Practice Address - Phone:703-854-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics