Healthcare Provider Details

I. General information

NPI: 1659954816
Provider Name (Legal Business Name): MINKI KIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 SAND POINT WAY NE STE 340
SEATTLE WA
98105-3941
US

IV. Provider business mailing address

12025 SLATER AVE NE
KIRKLAND WA
98034-5341
US

V. Phone/Fax

Practice location:
  • Phone: 206-985-0232
  • Fax:
Mailing address:
  • Phone: 917-456-6912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number70124924
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: