Provider Demographics
NPI:1457751273
Name:PETER E. KIM, DDS, PS
Entity Type:Organization
Organization Name:PETER E. KIM, DDS, PS
Other - Org Name:NORTH CASCADE IMPLANT AND ORAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-802-2799
Mailing Address - Street 1:2100 E SECTION ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9132
Mailing Address - Country:US
Mailing Address - Phone:360-424-7057
Mailing Address - Fax:360-424-7058
Practice Address - Street 1:2100 E SECTION ST STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9132
Practice Address - Country:US
Practice Address - Phone:360-424-7057
Practice Address - Fax:360-424-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60468228261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery