MEDICARE: DR. ERIC MINSU KIM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	61190122	WA

General Provider Information

NPI Number	:	1013680313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC MINSU KIM DDS

Provider Business Mailing Address
First Line	:	11216 NE 15TH ST STE A
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3724
Country	:	US
Telephone Number	:	425-454-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	11216 NE 15TH ST STE A
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3724
Country	:	US
Telephone Number	:	425-454-3221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2021
Last Update Date	:	08/01/2021

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