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General NPI Number Information
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NPI Number | 1811683667
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Entity Type | Organization
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Legal Business Name | YOUNG KIM DDS OF LAKE MANASSAS PLLC
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 7915 LAKE MANASSAS DR STE 115
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City | GAINESVILLE
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State | VA
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Zip | 20155-3259
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Country | US
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Telephone | 571-261-9470
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Fax |
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Provider Business Mailing Address
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Address Line | 41713 MCMONAGLE SQ
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City | ALDIE
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State | VA
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Zip | 20105-6028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. YOUNG KIM
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Credential | DDS
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Telephone | 571-261-9470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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