Provider Demographics
NPI:1316657109
Name:JOSEPH KIM DANIEL LEE & JOHN HODGES DDS PLLC
Entity type:Organization
Organization Name:JOSEPH KIM DANIEL LEE & JOHN HODGES DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-992-6817
Mailing Address - Street 1:3215 SE 192ND AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1469
Mailing Address - Country:US
Mailing Address - Phone:253-833-9914
Mailing Address - Fax:253-833-9914
Practice Address - Street 1:3215 SE 192ND AVE STE 112
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1469
Practice Address - Country:US
Practice Address - Phone:253-833-9914
Practice Address - Fax:253-833-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental