Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D10597 | OR |
Y | 1223G0001X | General Practice | DE60694716 | WA |
Y | 213EG0000X | General Practice | DE60694716 | WA |
NPI | 1003273509 |
---|---|
Provider Name | Dr. Junghee Kim |
First Address | Vancouver, WA 98665-9601 |
Second Address | Vancouver, WA 98665-9601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2016 |
Last Update Date | 03/12/2021 |