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General NPI Number Information
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NPI Number | 1912367210
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Entity Type | Organization
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Legal Business Name | CHUNG & KIM, DDS, PLLC
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 1200 112TH AVE NE STE B275
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City | BELLEVUE
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State | WA
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Zip | 98004-3732
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Country | US
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Telephone | 425-289-1918
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Fax | 425-451-4029
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Provider Business Mailing Address
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Address Line | 1200 112TH AVE NE STE B275
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City | BELLEVUE
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State | WA
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Zip | 98004-3732
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Country | US
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Telephone | 425-289-1918
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Fax | 425-451-4029
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | STEFANY M HENDERSON
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Credential |
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Telephone | 425-533-2655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60168936
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License Number State | WA
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