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General NPI Number Information
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NPI Number | 1396930517
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Entity Type | Individual
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Provider Name | NA-REE KIM MALAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 2274 N EAGLE RD SUITE 130
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City | MERIDIAN
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State | ID
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Zip | 83646-6615
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Country | US
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Telephone | 208-893-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 2274 N EAGLE RD SUITE 130
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City | MERIDIAN
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State | ID
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Zip | 83646-6615
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Country | US
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Telephone | 208-893-5440
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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 | DE00011089
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61540
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-4667
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License Number State | ID
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