Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1306091970 |
---|---|
Provider Name | Ms. Anastasia Ji Young Kim |
First Address | Redmond, WA 98052-0400 |
Second Address | Seattle, WA 98125-6358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2008 |
Last Update Date | 24/11/2008 |