Provider Demographics
NPI:1144658949
Name:KIM, YOOJIN (DDS)
Entity type:Individual
Prefix:DR
First Name:YOOJIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD PALISADE RD
Mailing Address - Street 2:APT 2513
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7064
Mailing Address - Country:US
Mailing Address - Phone:510-529-9647
Mailing Address - Fax:
Practice Address - Street 1:100 OLD PALISADE RD
Practice Address - Street 2:APT 2513
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7064
Practice Address - Country:US
Practice Address - Phone:510-529-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02552700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist