Healthcare Provider Details

I. General information

NPI: 1184638256
Provider Name (Legal Business Name): SUKHO KIM LICENSED DENTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 232ND ST SW
MOUNTLAKE TERRACE WA
98043-4738
US

IV. Provider business mailing address

5506 232ND ST SW
MOUNTLAKE TERRACE WA
98043-4738
US

V. Phone/Fax

Practice location:
  • Phone: 425-712-0915
  • Fax:
Mailing address:
  • Phone: 425-712-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000041
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: