Provider Demographics
NPI:1346655115
Name:TRIEU, KIM (DDS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TRIEU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 LAKE BALLINGER WAY
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8545
Mailing Address - Country:US
Mailing Address - Phone:206-227-9073
Mailing Address - Fax:
Practice Address - Street 1:10414 BEARDSLEE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3205
Practice Address - Country:US
Practice Address - Phone:425-424-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARR.60485858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist