Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60870448 | WA |
NPI | 1841767746 |
---|---|
Provider Name | Linda Kim |
First Address | Mountlake Terrace, WA 98043-4738 |
Second Address | Mountlake Terrace, WA 98043-4738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2018 |
Last Update Date | 29/10/2018 |