Provider Demographics
NPI:1578634606
Name:BRAIN, KIM E (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:E
Last Name:BRAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25726 SE 39TH ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7759
Mailing Address - Country:US
Mailing Address - Phone:425-391-6613
Mailing Address - Fax:
Practice Address - Street 1:720 S 320TH ST
Practice Address - Street 2:SUITE#I
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5254
Practice Address - Country:US
Practice Address - Phone:253-839-5953
Practice Address - Fax:253-839-9335
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice