Provider Demographics
NPI:1629499215
Name:KEE NAM KIM DDS PS
Entity Type:Organization
Organization Name:KEE NAM KIM DDS PS
Other - Org Name:GK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEE
Authorized Official - Middle Name:N
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-922-7910
Mailing Address - Street 1:10303 19TH AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4258
Mailing Address - Country:US
Mailing Address - Phone:425-357-8384
Mailing Address - Fax:425-357-8353
Practice Address - Street 1:10303 19TH AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4258
Practice Address - Country:US
Practice Address - Phone:425-357-8384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60114393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty