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General NPI Number Information
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NPI Number | 1831394352
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Entity Type | Individual
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Provider Name | YUNG KYUN KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | UNIVERSITY OF CONNECTICUT HEALTH CTR 263 FARMINGTON AVENUE
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City | FARMINGTON
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State | CT
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Zip | 06030-0001
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Country | US
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Telephone | 860-679-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 6470 CLOVERDALE BLVD
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2721
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Country | US
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Telephone | 917-375-9593
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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 | 053348-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 010754
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License Number State | CT
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