Healthcare Provider Details

I. General information

NPI: 1063336873
Provider Name (Legal Business Name): MIN-N-OUT DENTAL&DENTURE SERVICE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WASHINGTON AVE S
KENT WA
98032-5713
US

IV. Provider business mailing address

306 WASHINGTON AVE S
KENT WA
98032-5713
US

V. Phone/Fax

Practice location:
  • Phone: 253-981-3816
  • Fax: 253-981-3926
Mailing address:
  • Phone: 253-981-3816
  • Fax: 253-981-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. MINSEOK KIM
Title or Position: PRESIDENT
Credential:
Phone: 253-839-1505