Provider Demographics
NPI:1407975659
Name:KIM, YOUNG HO (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KNICKERBOCKER RD STE 3400
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1345
Mailing Address - Country:US
Mailing Address - Phone:201-227-7440
Mailing Address - Fax:201-277-7442
Practice Address - Street 1:300 KNICKERBOCKER RD STE 3400
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1345
Practice Address - Country:US
Practice Address - Phone:201-227-7440
Practice Address - Fax:201-277-7442
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2151100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010430Medicaid