Provider Demographics
NPI:1154515864
Name:HARANG, KIM MARIE (BA, RDH)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:HARANG
Suffix:
Gender:F
Credentials:BA, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 ISOLA PL NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-7847
Mailing Address - Country:US
Mailing Address - Phone:425-643-1739
Mailing Address - Fax:
Practice Address - Street 1:5205 ISOLA PL NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-7847
Practice Address - Country:US
Practice Address - Phone:425-643-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00005969124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist