Provider Demographics
NPI:1063573558
Name:KIM, JOE NAM HO (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:NAM HO
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NAM
Other - Middle Name:HO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:16405 SE 66TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5433
Mailing Address - Country:US
Mailing Address - Phone:425-643-2822
Mailing Address - Fax:
Practice Address - Street 1:2209 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5336
Practice Address - Country:US
Practice Address - Phone:206-788-4488
Practice Address - Fax:206-788-4487
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice