Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 60300984 | WA |
NPI | 1609208214 |
---|---|
Provider Name | Minseok Kim |
First Address | Federal Way, WA 98003-4902 |
Second Address | Federal Way, WA 98003-4982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2013 |
Last Update Date | 21/05/2021 |