Provider Demographics
NPI:1619025046
Name:KIM, CALVIN HYUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:HYUN
Last Name:KIM
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 1:7719 CENTER BLVD SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-8930
Mailing Address - Country:US
Mailing Address - Phone:425-396-5555
Mailing Address - Fax:425-396-5022
Practice Address - Street 1:7719 CENTER BLVD SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8930
Practice Address - Country:US
Practice Address - Phone:425-396-5555
Practice Address - Fax:425-396-5022
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice