Provider Demographics
NPI:1942468004
Name:KIM, KEE NAM (DDS)
Entity Type:Individual
Prefix:
First Name:KEE
Middle Name:NAM
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 1:10303 19TH AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4265
Mailing Address - Country:US
Mailing Address - Phone:425-357-8384
Mailing Address - Fax:425-357-8353
Practice Address - Street 1:10303 19TH AVE SE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4265
Practice Address - Country:US
Practice Address - Phone:425-357-8384
Practice Address - Fax:425-357-8353
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601143931223G0001X
CA563671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice