Healthcare Provider Details

I. General information

NPI: 1063233674
Provider Name (Legal Business Name): ALL FACIAL PROSTHETIC AND HEARING SERVICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WASHINGTON AVE S
KENT WA
98032-5713
US

IV. Provider business mailing address

308 WASHINGTON AVE S
KENT WA
98032-5713
US

V. Phone/Fax

Practice location:
  • Phone: 253-981-3917
  • Fax: 253-981-3926
Mailing address:
  • Phone: 253-981-3917
  • Fax: 253-981-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MINSEOK KIM
Title or Position: PRESIDENT
Credential: DD, LD, MSC
Phone: 253-886-3922