Healthcare Provider Details

I. General information

NPI: 1477483964
Provider Name (Legal Business Name): DAE YOUNG KIM, PLLC (D/B/A THE CORNER DENTAL)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 HERITAGE VILLAGE PLZ STE 102
GAINESVILLE VA
20155-3070
US

IV. Provider business mailing address

7200 HERITAGE VILLAGE PLZ STE 102
GAINESVILLE VA
20155-3070
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-4299
  • Fax:
Mailing address:
  • Phone: 703-348-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAE YOUNG KIM
Title or Position: OWNER
Credential:
Phone: 703-348-4299