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General NPI Number Information
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NPI Number | 1265495196
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Entity Type | Organization
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Legal Business Name | SUSAN KIM DDS
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 12910 TOTEM LAKE BLVD NE STE 103
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City | KIRKLAND
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State | WA
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Zip | 98034
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Country | US
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Telephone | 425-814-3196
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Fax | 425-825-9646
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Provider Business Mailing Address
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Address Line | 12910 TOTEM LAKE BLVD NE STE 103
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City | KIRKLAND
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State | WA
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Zip | 98034-2901
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Country | US
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Telephone | 425-814-3196
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Fax | 425-825-9646
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN S KIM
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Credential | DDS
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Telephone | 425-814-3196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9731
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License Number State | WA
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