Provider Demographics
NPI:1629380506
Name:CHRISTY A. KIM, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:CHRISTY A. KIM, D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-883-3800
Mailing Address - Street 1:2310 130TH AVE NE STE B-102
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1799
Mailing Address - Country:US
Mailing Address - Phone:425-883-3800
Mailing Address - Fax:425-869-6909
Practice Address - Street 1:2310 130TH AVE NE STE B-102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1799
Practice Address - Country:US
Practice Address - Phone:425-883-3800
Practice Address - Fax:425-869-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIN PROCESS261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental