Provider Demographics
NPI:1073599957
Name:YI, GIA KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:GIA
Middle Name:KIM
Last Name:YI
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OXFORD WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2577
Mailing Address - Country:US
Mailing Address - Phone:703-401-9654
Mailing Address - Fax:
Practice Address - Street 1:23 OXFORD WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-2577
Practice Address - Country:US
Practice Address - Phone:703-401-9654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00116031223X0400X
CADDS531841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics