Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DE00008656 | WA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | GA10000282 | WA |
NPI | 1093858318 |
---|---|
Provider Name | Peter H Kim |
First Address | Arlington, WA 98223-8415 |
Second Address | Arlington, WA 98223-8415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141618 | LABOR & INDUSTRIES (01) | WA |
5034640 | (05) | WA |
U96195 | (02) | WA |