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General NPI Number Information
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NPI Number | 1386784437
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Entity Type | Individual
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Provider Name | KEVIN K SHIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 SE 223RD AVE SUITE 260
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City | GRESHAM
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State | OR
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Zip | 97030-2574
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Country | US
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Telephone | 503-667-1184
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Fax |
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Provider Business Mailing Address
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Address Line | 13180 SE SNOWFIRE DR
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City | HAPPY VALLEY
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State | OR
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Zip | 97236-8022
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D8645
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License Number State | OR
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