Provider Demographics
NPI:1962726281
Name:KRIS KIM DDS PLLC
Entity type:Organization
Organization Name:KRIS KIM DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:HYEMIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:425-977-2505
Mailing Address - Street 1:21920 76TH AVE W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7980
Mailing Address - Country:US
Mailing Address - Phone:425-977-2505
Mailing Address - Fax:425-977-2506
Practice Address - Street 1:21920 76TH AVE W
Practice Address - Street 2:SUITE 201
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7980
Practice Address - Country:US
Practice Address - Phone:425-977-2505
Practice Address - Fax:425-977-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60058462305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization