Provider Demographics
NPI:1386784437
Name:SHIM, KEVIN K (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
Last Name:SHIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13180 SE SNOWFIRE DR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97236-8022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 SE 223RD AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2574
Practice Address - Country:US
Practice Address - Phone:503-667-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice