Provider Demographics
NPI:1306091970
Name:KIM, ANASTASIA JI YOUNG
Entity type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:JI YOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11733 167TH CT NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-0400
Mailing Address - Country:US
Mailing Address - Phone:206-852-2517
Mailing Address - Fax:
Practice Address - Street 1:11545 15TH AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6358
Practice Address - Country:US
Practice Address - Phone:206-852-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist