Provider Demographics
NPI:1760824361
Name:KIM, JAMIE JIYONG (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:JIYONG
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WHITCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2784
Mailing Address - Country:US
Mailing Address - Phone:301-792-2296
Mailing Address - Fax:
Practice Address - Street 1:609 WHITCLIFF CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2784
Practice Address - Country:US
Practice Address - Phone:301-792-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice