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General NPI Number Information
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NPI Number | 1104391614
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Entity Type | Organization
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Legal Business Name | YKIM DENTAL
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 2680 OPTIZ BLVD. SUITE 120
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 703-801-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 11410 ALESSI DR
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City | MANASSAS
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State | VA
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Zip | 20112
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Country | US
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Telephone | 703-801-6991
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | YONGHYUN KIM
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Credential | D.M.D.
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Telephone | 703-801-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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