Healthcare Provider Details

I. General information

NPI: 1780112714
Provider Name (Legal Business Name): KIMBERLIE YUN, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 06/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S VAN BRUNT ST # 404
ENGLEWOOD NJ
07631-4604
US

IV. Provider business mailing address

401 S VAN BRUNT ST # 404
ENGLEWOOD NJ
07631-4604
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-5667
  • Fax: 201-567-5646
Mailing address:
  • Phone: 201-567-5667
  • Fax: 201-567-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: KIMBERLIE YUN
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 832-661-8200