Provider Demographics
NPI:1316696933
Name:YK DENTAL CHANTILLY PC
Entity type:Organization
Organization Name:YK DENTAL CHANTILLY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNGDAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DMD
Authorized Official - Phone:703-300-3548
Mailing Address - Street 1:4265B BROOKFIELD CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1696
Mailing Address - Country:US
Mailing Address - Phone:703-848-5555
Mailing Address - Fax:703-574-1611
Practice Address - Street 1:4265B BROOKFIELD CORPORATE DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1696
Practice Address - Country:US
Practice Address - Phone:703-848-5555
Practice Address - Fax:703-574-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental