1740431451 NPI number — DR. EDMOND L KIM D.D.S

Table of content: DR. EDMOND L KIM D.D.S (NPI 1740431451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740431451 NPI number — DR. EDMOND L KIM D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
EDMOND
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S
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:
PAMELA
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OFFICE MANAGER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1740431451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4909 S COAST HWY STE 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEACH
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97366-9654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-867-3755
Provider Business Mailing Address Fax Number:
541-867-3756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4909 S COAST HWY STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEACH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97366-9654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-867-3755
Provider Business Practice Location Address Fax Number:
541-867-3756
Provider Enumeration Date:
10/01/2008

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: 122300000X , with the licence number:  8330 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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