Provider Demographics
NPI:1437584349
Name:MIN-N-OUT DENTAL&DENTURE SERVICE CORP.
Entity Type:Organization
Organization Name:MIN-N-OUT DENTAL&DENTURE SERVICE CORP.
Other - Org Name:MIN-N-OUT DENTAL&DENTURE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/DENTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MINSEOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DD,LD
Authorized Official - Phone:253-839-1505
Mailing Address - Street 1:30810 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4982
Mailing Address - Country:US
Mailing Address - Phone:253-839-1505
Mailing Address - Fax:253-941-3896
Practice Address - Street 1:30810 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4982
Practice Address - Country:US
Practice Address - Phone:253-839-1505
Practice Address - Fax:253-941-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60300984122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Multi-Specialty