Provider Demographics
NPI:1194134064
Name:YUN, KIMBERLIE A (DMD)
Entity type:Individual
Prefix:
First Name:KIMBERLIE
Middle Name:A
Last Name:YUN
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 1:350 W 43RD ST APT 29F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6475
Mailing Address - Country:US
Mailing Address - Phone:832-661-8200
Mailing Address - Fax:
Practice Address - Street 1:401 S VAN BRUNT ST # 404
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-567-5667
Practice Address - Fax:201-567-5646
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI025812001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice