Provider Demographics
NPI:1790848471
Name:KIM, KEVIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
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 1:6001 100TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2733
Mailing Address - Country:US
Mailing Address - Phone:253-582-5050
Mailing Address - Fax:253-276-5956
Practice Address - Street 1:KIM, JUNG, STEVENS, STEVENS, DDS PS
Practice Address - Street 2:6001 100TH ST SW
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2733
Practice Address - Country:US
Practice Address - Phone:253-582-5050
Practice Address - Fax:253-276-5956
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice