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NPI Code Detail

MEDICARE: KWANG HYO KIM, DDS, PLLC

MEDICARE: KWANG HYO KIM, DDS, PLLC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1093485146
Entity Type Code : Organization
Provider Name (Legal Business Name) : KWANG HYO KIM, DDS, PLLC
Provider Business Mailing Address
First Line : 4307 FACTORIA BLVD SE STE 1
Second Line :
City : BELLEVUE
State : WA
Zip : 98006-1936
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4307 FACTORIA BLVD SE STE 1
Second Line :
City : BELLEVUE
State : WA
Zip : 98006-1936
Country : US
Telephone Number : 425-747-8788
Fax Number :
Authorized Official
Title or Position : OWNER DENTIST
Name : KWANG HYO KIM
Credential :
Telephone Number : 206-398-9799
Provider Enumeration Date : 09/20/2021
Last Update Date : 03/18/2026

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