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General NPI Number Information
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NPI Number | 1114871738
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Entity Type | Individual
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Provider Name | JI EUN KIM
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Gender |
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Dates
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Enumeration Date | 02/21/2026
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Last Update Date | 02/21/2026
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Provider Practice Location Address
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Address Line | 1959 NE PACIFIC ST # B-338
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City | SEATTLE
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State | WA
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Zip | 98195-7446
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Country | US
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Telephone | 206-543-5787
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Fax |
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Provider Business Mailing Address
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Address Line | 3974 PENNSYLVANIA AVE UNIT 102
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3794
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Country | US
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Telephone | 818-934-2915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 112085
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License Number State | CA
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