Provider Demographics
NPI:1861503179
Name:KIM, JIN YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:YOUNG
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 1:11819 98TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4214
Mailing Address - Country:US
Mailing Address - Phone:425-284-4450
Mailing Address - Fax:425-284-4451
Practice Address - Street 1:11819 98TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4214
Practice Address - Country:US
Practice Address - Phone:425-284-4450
Practice Address - Fax:425-284-4451
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE93101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
5047741Medicare UPIN