Provider Demographics
NPI:1043406507
Name:JI KIM-AUN, DDS, PRASITH KIM-AUN, DDS, PLLC
Entity Type:Organization
Organization Name:JI KIM-AUN, DDS, PRASITH KIM-AUN, DDS, PLLC
Other - Org Name:AMBAUM DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JI
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:KIM-AUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-244-0956
Mailing Address - Street 1:14400 AMBAUM BLVD SW
Mailing Address - Street 2:SUITE Q
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1446
Mailing Address - Country:US
Mailing Address - Phone:206-244-0956
Mailing Address - Fax:206-244-1017
Practice Address - Street 1:14400 AMBAUM BLVD SW
Practice Address - Street 2:SUITE Q
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1446
Practice Address - Country:US
Practice Address - Phone:206-244-0956
Practice Address - Fax:206-244-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE96091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty