Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000041 | WA |
NPI | 1184638256 |
---|---|
Provider Name | Mr. Sukho Kim |
First Address | Mountlake Terrace, WA 98043-4738 |
Second Address | Mountlake Terrace, WA 98043-4738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5021282 | (05) | WA |