Provider Demographics
NPI:1689760415
Name:KIM, SANG C (DDS)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:C
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 1:344 MORRIS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2521
Mailing Address - Country:US
Mailing Address - Phone:425-255-3576
Mailing Address - Fax:425-226-6313
Practice Address - Street 1:344 MORRIS AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2521
Practice Address - Country:US
Practice Address - Phone:425-255-3576
Practice Address - Fax:425-226-6313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA94941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice