=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063336873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIN-N-OUT DENTAL&DENTURE SERVICE CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2026
-----------------------------------------------------
Last Update Date | 08/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 308 WASHINGTON AVE S
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98032-5713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-981-3816
-----------------------------------------------------
Fax | 253-981-3926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 WASHINGTON AVE S
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98032-5713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-981-3816
-----------------------------------------------------
Fax | 253-981-3926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MINSEOK KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-839-1505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122400000X
-----------------------------------------------------
Taxonomy Name | Denturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------