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General NPI Number Information
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NPI Number | 1124435771
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Entity Type | Individual
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Provider Name | FRED YOUNG KIM D.M.D
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Gender | Male
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 1705 AMHERST ST STE 201
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City | WINCHESTER
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State | VA
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Zip | 22601-3346
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Country | US
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Telephone | 540-667-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 AMHERST ST STE 201
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City | WINCHESTER
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State | VA
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Zip | 22601-3346
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Country | US
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Telephone | 540-667-5437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 33184
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401416364
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License Number State | VA
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