Provider Demographics
NPI:1306855150
Name:KIM-SIODA, SYLVIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:KIM-SIODA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N PEARL ST
Mailing Address - Street 2:SUITE A5
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2461
Mailing Address - Country:US
Mailing Address - Phone:253-759-7941
Mailing Address - Fax:253-759-5235
Practice Address - Street 1:1919 N PEARL ST
Practice Address - Street 2:SUITE A5
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2461
Practice Address - Country:US
Practice Address - Phone:253-759-7941
Practice Address - Fax:253-759-5235
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000076651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5025945Medicaid