Healthcare Provider Details

I. General information

NPI: 1598613630
Provider Name (Legal Business Name): JOHN T. KIM DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18920 BOTHELL WAY NE STE 202
BOTHELL WA
98011-1981
US

IV. Provider business mailing address

18920 BOTHELL WAY NE STE 202
BOTHELL WA
98011-1981
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-0509
  • Fax: 425-481-0569
Mailing address:
  • Phone: 425-481-0509
  • Fax: 425-481-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN T KIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 425-512-2111