MEDICARE: JADE K KIM D.D.S.

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	122300000X	Dentist	DE00007947	WA

General Provider Information

NPI Number	:	1760560874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE K KIM D.D.S.

Provider Business Mailing Address
First Line	:	1216 26TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3631
Country	:	US
Telephone Number	:	206-713-2544
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 N 45TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6968
Country	:	US
Telephone Number	:	206-632-1214
Fax Number	:	206-634-1229

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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