MEDICARE: ASHLEY Y. KI DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	048754	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407019417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY Y. KI DENTAL PC

Provider Business Mailing Address
First Line	:	16410 NORTHERN BLVD
Second Line	:	SUITE #214
City	:	FLUSHING
State	:	NY
Zip	:	11358-2668
Country	:	US
Telephone Number	:	718-321-7181
Fax Number	:	718-321-7197

Provider Business Practice Location Address
First Line	:	16410 NORTHERN BLVD
Second Line	:	SUITE #214
City	:	FLUSHING
State	:	NY
Zip	:	11358-2668
Country	:	US
Telephone Number	:	718-321-7181
Fax Number	:	718-321-7197

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ASHLEY YONSOOK KI
Credential	:	D.D.S.
Telephone Number	:	718-321-7181

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	07/09/2008

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