Healthcare Provider Details

I. General information

NPI: 1417873522
Provider Name (Legal Business Name): JAE SEON KIM DDS MSD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 WESTLAKE AVE N STE 204
SEATTLE WA
98109-2753
US

IV. Provider business mailing address

2046 WESTLAKE AVE N STE 204
SEATTLE WA
98109-2753
US

V. Phone/Fax

Practice location:
  • Phone: 206-284-4505
  • Fax: 206-284-4757
Mailing address:
  • Phone: 206-284-4505
  • Fax: 206-284-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAE SEON KIM
Title or Position: OWNER
Credential: DDS, MSD
Phone: 206-371-5462