Provider Demographics
NPI:1578863999
Name:EUNICE KIM, DDS, PLLC
Entity Type:Organization
Organization Name:EUNICE KIM, DDS, PLLC
Other - Org Name:GENTLE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:YOOSEUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-424-1990
Mailing Address - Street 1:2100 E SECTION ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9132
Mailing Address - Country:US
Mailing Address - Phone:360-424-1990
Mailing Address - Fax:360-424-1994
Practice Address - Street 1:2100 E SECTION ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9132
Practice Address - Country:US
Practice Address - Phone:360-424-1990
Practice Address - Fax:360-424-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600783491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty