Provider Demographics
NPI:1639108152
Name:KIM, YONGJAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:YONGJAE
Middle Name:
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:PO BOX 4086
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-4086
Mailing Address - Country:US
Mailing Address - Phone:425-457-3638
Mailing Address - Fax:
Practice Address - Street 1:3333 184TH ST SW
Practice Address - Street 2:STE U
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4724
Practice Address - Country:US
Practice Address - Phone:425-251-0707
Practice Address - Fax:425-608-5642
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0354321223G0001X
WADE000111161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice