Basic Information
| Provider Information | |||||||||
| NPI: | 1386929776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | JEE | ||||||||
| MiddleName: | YOUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | BLDG 320 KRUKOWSKI ST | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | 8084333928 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 320 KRUKOWSKI ST | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | 8084333928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2011 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 60729 | CA | N | Dental Providers | Dentist | 1223P0700X | 60729 | CA | Y | Dental Providers | Dentist | Prosthodontics |
No ID Information.