Basic Information
| Provider Information | |||||||||
| NPI: | 1417110669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | YOUNGSUN | ||||||||
| MiddleName: | ALICE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 SAINT PAUL ST # 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024466501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035067479 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 LONGWOOD AVE | ||||||||
| Address2: | HUNNEWELL BUILDING 4TH FLOOR | ||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173554426 | ||||||||
| FaxNumber: | 6177300478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 07/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 22211 | MA | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.