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General NPI Number Information
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NPI Number | 1780447532
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Entity Type | Organization
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Legal Business Name | CATHERINE B. KIM, DMD, L.L.C.
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 14649 SW TEAL BLVD STE 649
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City | BEAVERTON
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State | OR
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Zip | 97007-6194
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Country | US
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Telephone | 503-516-4425
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Fax |
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Provider Business Mailing Address
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Address Line | 12021 NW SCHALL ST
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City | PORTLAND
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State | OR
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Zip | 97229-2552
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Country | US
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Telephone | 503-516-4425
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. CATHERINE BOM KIM
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Credential | DMD
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Telephone | 503-516-4425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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