Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE00009731 | WA |
NPI | 1033219936 |
---|---|
Provider Name | Dr. Susan S Kim |
First Address | Bellevue, WA 98006-6105 |
Second Address | Bellevue, WA 98006-6105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |