Provider Demographics
NPI:1124368550
Name:TAKASAKI, SONIA KIM (DMD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:KIM
Last Name:TAKASAKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:JIHAE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:9730 3RD AVE NE STE 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2023
Mailing Address - Country:US
Mailing Address - Phone:206-524-5700
Mailing Address - Fax:
Practice Address - Street 1:9730 3RD AVE NE STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2023
Practice Address - Country:US
Practice Address - Phone:206-524-5700
Practice Address - Fax:206-524-0675
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE606349981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice