Provider Demographics
NPI:1760560874
Name:KIM, JADE K (DDS)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:K
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 1:1216 26TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3631
Mailing Address - Country:US
Mailing Address - Phone:206-713-2544
Mailing Address - Fax:
Practice Address - Street 1:2401 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6968
Practice Address - Country:US
Practice Address - Phone:206-632-1214
Practice Address - Fax:206-634-1229
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist