MEDICARE: DR. DAE HO KIM DDS

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	1223G0001X	General Practice Dentistry	DE60307878	WA
2	122300000X	Dentist	DE60307878	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275869000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAE HO KIM DDS

Provider Business Mailing Address
First Line	:	5929 EVERGREEN WAY STE 100
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-6031
Country	:	US
Telephone Number	:	425-353-4469
Fax Number	:	425-348-5216

Provider Business Practice Location Address
First Line	:	5929 EVERGREEN WAY STE 100
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-6031
Country	:	US
Telephone Number	:	425-353-4469
Fax Number	:	425-348-5216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	03/30/2026

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Directions to “ DR. DAE HO KIM DDS” Practice Location

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