Healthcare Provider Details

I. General information

NPI: 1841475761
Provider Name (Legal Business Name): SAVANNAH JIYOUNG KIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JI YOUNG KIM DDS

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLD MIDDLETOWN RD # 207
PEARL RIVER NY
10965-2637
US

IV. Provider business mailing address

1 OLD MIDDLETOWN RD # 207
PEARL RIVER NY
10965-2637
US

V. Phone/Fax

Practice location:
  • Phone: 845-536-8387
  • Fax: 888-886-7545
Mailing address:
  • Phone: 845-536-8387
  • Fax: 888-886-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14543
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number56483
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number063803-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: