Provider Demographics
NPI:1306010350
Name:SOON H. KIMM, M.D., P.C.
Entity Type:Organization
Organization Name:SOON H. KIMM, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-542-7606
Mailing Address - Street 1:1207 N 200TH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-542-7606
Mailing Address - Fax:206-533-9880
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-542-7606
Practice Address - Fax:206-533-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022272261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112747Medicaid
WAG000102735Medicare PIN
WA1112747Medicaid