MEDICARE: HANNA S KIM DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DE60147287	WA

General Provider Information

NPI Number	:	1184045437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNA S KIM DDS INC

Provider Business Mailing Address
First Line	:	827 HIAWATHA PL S
Second Line	:	SUITE 102
City	:	SEATTLE
State	:	WA
Zip	:	98144-2847
Country	:	US
Telephone Number	:	206-605-5321
Fax Number	:

Provider Business Practice Location Address
First Line	:	827 HIAWATHA PL S
Second Line	:	SUITE 102
City	:	SEATTLE
State	:	WA
Zip	:	98144-2847
Country	:	US
Telephone Number	:	206-605-5321
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HANNA S KIM
Credential	:	DDS
Telephone Number	:	206-605-5321

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	01/03/2014

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