MEDICARE: EUNICE 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
1	1223G0001X	General Practice Dentistry	DE60078349	WA

General Provider Information

NPI Number	:	1578863999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUNICE KIM, DDS, PLLC

Provider Business Mailing Address
First Line	:	2100 E SECTION ST
Second Line	:	SUITE 101
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-9132
Country	:	US
Telephone Number	:	360-424-1990
Fax Number	:	360-424-1994

Provider Business Practice Location Address
First Line	:	2100 E SECTION ST
Second Line	:	SUITE 101
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-9132
Country	:	US
Telephone Number	:	360-424-1990
Fax Number	:	360-424-1994

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. EUNICE YOOSEUNG KIM
Credential	:	D.D.S
Telephone Number	:	360-424-1990

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	11/02/2010

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