Provider Demographics
NPI:1134442429
Name:KIM, KRIS (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21920 76TH AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7980
Mailing Address - Country:US
Mailing Address - Phone:425-977-2505
Mailing Address - Fax:425-977-2506
Practice Address - Street 1:21920 76TH AVE W STE 201
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7980
Practice Address - Country:US
Practice Address - Phone:425-977-2505
Practice Address - Fax:425-977-2506
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600584621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE60058462OtherWASHINGTON STATE DENTAL LICENSE