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General NPI Number Information
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NPI Number | 1487027538
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Entity Type | Individual
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Provider Name | LUCAS KIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 33516 9TH AVE S STE 3
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6322
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Country | US
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Telephone | 253-815-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 10610 NE 9TH PL UNIT 1602
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City | BELLEVUE
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State | WA
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Zip | 98004-8644
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Country | US
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Telephone | 253-350-7975
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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 | D009363
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License Number State | AZ
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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 | 60902595
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License Number State | WA
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