Healthcare Provider Details

I. General information

NPI: 1174066484
Provider Name (Legal Business Name): COMFY DENTURE & HEARING SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18802 MOUNTAIN VIEW DR E
BONNEY LAKE WA
98391-7110
US

IV. Provider business mailing address

16014 24TH ST E
LAKE TAPPS WA
98391-4908
US

V. Phone/Fax

Practice location:
  • Phone: 253-886-0855
  • Fax: 253-941-3896
Mailing address:
  • Phone: 253-886-0855
  • Fax: 253-941-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN60300984
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA60239129
License Number StateWA

VIII. Authorized Official

Name: MR. MINSEOK KIM
Title or Position: PRESIDENT
Credential: DD,LD.
Phone: 253-886-0855