Healthcare Provider Details

I. General information

NPI: 1164579447
Provider Name (Legal Business Name): KATIE H KIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S 320TH ST
FEDERAL WAY WA
98003-5400
US

IV. Provider business mailing address

2572 UNION AVE NE
RENTON WA
98059-3501
US

V. Phone/Fax

Practice location:
  • Phone: 206-400-0800
  • Fax:
Mailing address:
  • Phone: 425-271-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00010585
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: