Healthcare Provider Details

I. General information

NPI: 1649633538
Provider Name (Legal Business Name): YESLE KIM D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YESLE KIM TRABAND DMD

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 TOWNSHIP LINE RD FL 2
DREXEL HILL PA
19026-4221
US

IV. Provider business mailing address

4750 TOWNSHIP LINE RD FL 2
DREXEL HILL PA
19026-4221
US

V. Phone/Fax

Practice location:
  • Phone: 610-449-7002
  • Fax:
Mailing address:
  • Phone: 610-449-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040813
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: