1063573558 NPI number — DR. JOE NAM HO KIM DDS

Table of content: DR. JOE NAM HO KIM DDS (NPI 1063573558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063573558 NPI number — DR. JOE NAM HO KIM DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JOE
Provider Middle Name:
NAM HO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
NAM
Provider Other Middle Name:
HO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063573558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16405 SE 66TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98006-5433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-643-2822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2209 E MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-5336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-788-4488
Provider Business Practice Location Address Fax Number:
206-788-4487
Provider Enumeration Date:
12/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00008997 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)