Healthcare Provider Details

I. General information

NPI: 1598691222
Provider Name (Legal Business Name): JI YON KIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BIG BETHEL RD
HAMPTON VA
23666-1906
US

IV. Provider business mailing address

105 NOTTOWAY TURN
YORKTOWN VA
23693-2728
US

V. Phone/Fax

Practice location:
  • Phone: 757-909-6879
  • Fax:
Mailing address:
  • Phone: 757-375-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420119
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: