Provider Demographics
NPI:1609464817
Name:KIM, HAYDEN HYEYEON
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:HYEYEON
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16014 ASH WAY APT N105
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8527
Mailing Address - Country:US
Mailing Address - Phone:360-224-2864
Mailing Address - Fax:
Practice Address - Street 1:7102 S 220TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1946
Practice Address - Country:US
Practice Address - Phone:800-562-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program