Healthcare Provider Details

I. General information

NPI: 1073599957
Provider Name (Legal Business Name): GIA KIM YI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 04/02/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 OXFORD WAY
WILMINGTON DE
19807-2577
US

IV. Provider business mailing address

23 OXFORD WAY
WILMINGTON DE
19807-2577
US

V. Phone/Fax

Practice location:
  • Phone: 703-401-9654
  • Fax:
Mailing address:
  • Phone: 703-401-9654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberG1-0011603
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS53184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: