Provider Demographics
NPI:1386929776
Name:KIM, JEE YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:JEE
Middle Name:YOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BLDG 320 KRUKOWSKI ST
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5000
Mailing Address - Country:US
Mailing Address - Phone:808-433-1021
Mailing Address - Fax:808-433-3928
Practice Address - Street 1:BLDG 320 KRUKOWSKI ST
Practice Address - Street 2:USA DENTAC
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-433-1021
Practice Address - Fax:808-433-3928
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60729122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist