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General NPI Number Information
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NPI Number | 1447820360
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Entity Type | Individual
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Provider Name | JOHN YOUNGKWANG KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 3114 QUEENS CHAPEL RD
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City | HYATTSVILLE
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State | MD
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Zip | 20782-3665
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Country | US
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Telephone | 301-338-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 2621 JAMESTOWN LN APT 103
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City | ALEXANDRIA
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State | VA
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Zip | 22314-5882
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Country | US
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Telephone | 703-678-1131
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 17720
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License Number State | MD
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