Healthcare Provider Details

I. General information

NPI: 1912533464
Provider Name (Legal Business Name): FAMILY DENTISTRY- DR. YOOSON KIM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 HERITAGE DR
ELVERSON PA
19520-9324
US

IV. Provider business mailing address

3411 MAIN ST
MORGANTOWN PA
19543-7748
US

V. Phone/Fax

Practice location:
  • Phone: 610-286-0312
  • Fax:
Mailing address:
  • Phone: 610-286-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. YOOSON E KIM
Title or Position: OWNER
Credential: DMD
Phone: 610-286-0312