Provider Demographics
NPI:1780112714
Name:KIMBERLIE YUN, DMD, LLC
Entity type:Organization
Organization Name:KIMBERLIE YUN, DMD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:832-661-8200
Mailing Address - Street 1:401 S VAN BRUNT ST # 404
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4604
Mailing Address - Country:US
Mailing Address - Phone:201-567-5667
Mailing Address - Fax:201-567-5646
Practice Address - Street 1:401 S VAN BRUNT ST # 404
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-567-5667
Practice Address - Fax:201-567-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-04
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental