Provider Demographics
NPI:1396980611
Name:KIM, DO YOON (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:DO YOON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LINWOOD AVE APT 12T
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3157
Mailing Address - Country:US
Mailing Address - Phone:917-673-9491
Mailing Address - Fax:
Practice Address - Street 1:901 MOUNTAIN AVE # SC13
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3414
Practice Address - Country:US
Practice Address - Phone:973-315-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0614381223S0112X
CT103261223S0112X
NY307534204E00000X
NJ22DI023912001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery