Healthcare Provider Details

I. General information

NPI: 1710869565
Provider Name (Legal Business Name): YE JI KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7069 ARUNDEL MILLS BLVD
HANOVER MD
21076
US

IV. Provider business mailing address

8664 N CEDAR AVE APT 203
FRESNO CA
93720-4807
US

V. Phone/Fax

Practice location:
  • Phone: 833-824-3079
  • Fax:
Mailing address:
  • Phone: 424-626-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18938
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: