Provider Demographics
NPI:1386053973
Name:DAE HO KIM DDS PC INC
Entity type:Organization
Organization Name:DAE HO KIM DDS PC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAE
Authorized Official - Middle Name:HO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-353-4469
Mailing Address - Street 1:5929 EVERGREEN WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6031
Mailing Address - Country:US
Mailing Address - Phone:425-353-4469
Mailing Address - Fax:
Practice Address - Street 1:5929 EVERGREEN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6031
Practice Address - Country:US
Practice Address - Phone:425-353-4469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60307878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty