Healthcare Provider Details

I. General information

NPI: 1396639175
Provider Name (Legal Business Name): YOUKYUNG KIM DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE KIM DDS, MSD

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 OCEAN AVE STE 2
JERSEY CITY NJ
07305-3812
US

IV. Provider business mailing address

1319 ANDERSON AVE APT 21
FORT LEE NJ
07024-1734
US

V. Phone/Fax

Practice location:
  • Phone: 551-554-3500
  • Fax:
Mailing address:
  • Phone: 201-316-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI03146200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: