Provider Demographics
NPI:1609208214
Name:KIM, MINSEOK (DD,LD)
Entity Type:Individual
Prefix:
First Name:MINSEOK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30818 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4902
Mailing Address - Country:US
Mailing Address - Phone:253-839-1505
Mailing Address - Fax:253-941-3896
Practice Address - Street 1:30810 PACIFIC HWY S STE B
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:253-886-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 60300984122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist