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General NPI Number Information
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NPI Number | 1619250016
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Entity Type | Organization
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Legal Business Name | SAM D.K. KIM, DMD, PLLC
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 1412 SW 43RD ST STE 109
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 425-999-1281
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 SW 43RD ST STE 109
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 425-999-1281
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONG KYUNG KIM
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Credential | DMD
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Telephone | 425-999-1281
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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 | DE60127882
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License Number State | WA
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