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General NPI Number Information
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NPI Number | 1457703001
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Entity Type | Individual
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Provider Name | SEI JIN KIM D.M.D
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Gender | Female
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 742 NE DIVISION ST STE 102
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City | GRESHAM
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State | OR
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Zip | 97030-3979
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Country | US
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Telephone | 503-667-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 SW HARBOR WAY UNIT 405
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City | PORTLAND
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State | OR
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Zip | 97201-5100
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Country | US
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Telephone | 503-810-4806
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D11053
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License Number State | OR
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