Provider Demographics
NPI:1740740752
Name:KIM, JANICE JIHEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:JIHEE
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27072 SW BALLSTON RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-9620
Mailing Address - Country:US
Mailing Address - Phone:503-843-6461
Mailing Address - Fax:
Practice Address - Street 1:27072 SW BALLSTON RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378-9620
Practice Address - Country:US
Practice Address - Phone:503-843-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901017715OtherDENTAL LICENSE