Provider Demographics
NPI:1558416586
Name:KIM AUN DDS PS
Entity Type:Organization
Organization Name:KIM AUN DDS PS
Other - Org Name:UNIVERSITY PLACE FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM-AUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-564-2701
Mailing Address - Street 1:2607 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4700
Mailing Address - Country:US
Mailing Address - Phone:253-564-2701
Mailing Address - Fax:253-566-3638
Practice Address - Street 1:2607 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 1K
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4700
Practice Address - Country:US
Practice Address - Phone:253-564-2701
Practice Address - Fax:253-566-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE91561223G0001X
WADE96091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty